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    v1.0.30
    OpenPayerBilling CodesProprietary Laboratory AnalysesCPT cpt-0516u-mygenvar-pharmacogenomics-test-40-genes-cyp2d6
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    CPT 0516U: MyGenVar Pharmacogenomics Test, 40-Gene with CYP2D6 Copy Number

    CPT code 0516U is a Proprietary Laboratory Analyses (PLA) code for the MyGenVar Pharmacogenomics Test from Geisinger Medical Laboratories; it represents a pharmacogenomic genotyping service that analyzes 40 genes plus CYP2D6 copy number variants using whole blood to report a patient’s metabolizer status. The service type is pharmacogenomic genotyping and the typical site of service is a clinical laboratory performing specialized molecular diagnostic testing.

    For related coverage guidance, see recent payer policy updates: Biomarker Testing Mandate, Prenatal (Fetal) Diagnostic Testing, Oral Cancer Screening and Testing.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 52-year-old patient with multiple chronic conditions (depression on selective serotonin reuptake inhibitor, hypertension, and chronic pain treated with opioids) is referred for pharmacogenomic testing to guide medication selection and dosing. The clinician orders the MyGenVar Pharmacogenomics Test (Geisinger Medical Laboratories) to analyze 40 pharmacogenes and CYP2D6 copy number variants using a whole blood specimen. The specimen is collected in an outpatient phlebotomy setting or during an ambulatory clinic visit. The sample is sent to the performing laboratory where genotyping and CYP2D6 copy-number analysis are completed, and a report is returned describing metabolizer status for actionable genes and recommended genotype-guided drug adjustments. Typical clinical workflow: clinician documents medication history and rationale, obtains informed consent when required, collects whole blood sample, ships sample to Geisinger Medical Laboratories, receives structured lab report, and integrates results into the electronic health record for medication optimization discussions with the patient.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    36415Collection of venous blood by venipunctureOften performed immediately before sending sample for the pharmacogenomic test
    99000Handling and/or conveyance of specimen for transfer from phlebotomy site to laboratoryUsed when facility bills for special specimen transport services per payer policy
    0054UPharmacogenomic panel (example PLA)Other pharmacogenomic PLA codes may be ordered in parallel when different vendor tests are used (laboratory-dependent)
    80307Drug metabolizing enzyme genotype, common variantsSingle-gene pharmacogenomic tests sometimes ordered when confirmatory or limited testing is requested alongside a broad panel
    81025Urine drug screen, presumptive, different classesMedication monitoring tests frequently performed in patients whose therapy will be adjusted based on pharmacogenomic results

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208D00000X
    207Q00000X
    207L00000X
    207P00000X
    363LF0000X
    133VN1301X
    171R00000X
    207ZM0300X

    Related ICD-10-CM Codes

    25 rows

    ICD-10-CM CodeDescription
    B37.9Candidiasis, unspecified
    C50.912Malignant neoplasm of unspecified site of left female breast
    D50.9Iron deficiency anemia, unspecified
    E03.9Hypothyroidism, unspecified
    E11.9Type 2 diabetes mellitus without complications
    E78.5Hyperlipidemia, unspecified
    F10.20Alcohol dependence, uncomplicated
    F32.9Major depressive disorder, single episode, unspecified
    F33.1Major depressive disorder, recurrent, moderate
    F33.9Major depressive disorder, recurrent, unspecified

    Showing 1–10 of 25

    Related Payer Policy Updates

    Specialty: Genetic & Molecular Testing1 / 3

    10 rows

    PolicyPayerEffective Date
    Biomarker Testing MandateBlue Cross Blue Shield - Rhode Island2027-01-01
    Prenatal (Fetal) Diagnostic TestingBlue Cross Blue Shield - Rhode Island2027-01-01
    Oral Cancer Screening and TestingOscar Health2027-01-01
    RTM Testing for Alpha-1 Antitrypsin DeficiencyOscar Health2027-01-01
    Cytochrome P450 Genotype-Guided Treatment Strategy Corporate Medical Policybcbsvermont2027-01-01
    Polygenic Risk ScoreBlue Cross Blue Shield - Rhode Island2026-12-01
    Gene Expression Profiling for Cutaneous MelanomaBlue Cross Blue Shield - Rhode Island2026-12-01
    Pharmacogenetic Panel Testing (for Ohio Only)Colorado Rocky Mountain Health Plans2026-11-01
    Cell-Free Fetal DNA Testing (for Kansas Only)Colorado Rocky Mountain Health Plans2026-11-01
    Genetic Testing for Neurological Disorders (for Kentucky Only)Colorado Rocky Mountain Health Plans2026-11-01

    Related Codes

    CPT-0001U-PRECISETYPE-HEA-MULTIPLEX-RBC-ANTIGEN-GENOTYPING

    CPT 0001U: PreciseType HEA Erythrocyte Antigen Genotyping

    CPT-0002U-POLYPDX-URINE-METABOLOMIC-ASSAY-ADENOMATOUS-POLYP-RISK

    CPT 0002U: PolypDX™ Urine Metabolomic Risk Assay

    CPT-0003U-OVAR-A-NEXT-GENERATION-OVARIAN-CANCER-RISK-ASSAY

    CPT 0003U: Overa (MIA2G) Ovarian Cancer Risk Assay

    CPT-0005U-PROSTATE-EXOSOMEDX-INTELLISCORE-GENE-EXPRESSION-URINE-TEST

    CPT 0005U: ExosomeDx Prostate (IntelliScore) urine gene expression test

    CPT-0007U-TOXPROTECT-URINE-DRUG-SCREEN-WITH-DNA-AUTHENTICATION

    CPT 0007U: ToxProtect Urine Drug Screen With DNA Authentication

    CPT-0008U-H-PYLORI-ANTIBIOTIC-RESISTANCE-SEQUENCING-PANEL

    CPT 0008U: H. pylori Antibiotic Resistance Gene Panel

    CPT-0009U-DEPARRAY-HER2-FISH-TUMOR-CELL-ISOLATION

    CPT 0009U: DEPArray HER2 Tumor‑Cell Isolation with FISH Analysis

    CPT-0010U-BACTERIAL-TYPING-WHOLE-GENOME-SEQUENCING-MAYO-CLINIC

    CPT 0010U: Bacterial Typing by Whole Genome Sequencing, Mayo Clinic

    CPT-0011U-CORDANT-CORE-ALGORITHMIC-ORAL-FLUID-DRUG-TEST

    CPT 0011U: Oral Fluid Drug Test with Algorithmic Steady‑State Comparison

    CPT-0016U-BCR-ABL1-MAJOR-MINOR-FUSION-TRANSCRIPT-TESTING

    CPT 0016U: BCR–ABL1 Major and Minor Breakpoint Fusion Transcripts

    Showing 1–10 of 536

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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