Summary & Overview
CPT 0542U: Kidney Transplant Monitoring with Urine Metabolites and BK PCR
CPT code 0542U designates a Proprietary Laboratory Analyses (PLA) test — myOLARIS™–KTdx from Olaris® Inc. — designed to monitor kidney transplant health. The test combines targeted urine metabolomics (84 analytes), BK virus detection by real‑time PCR, and a serum creatinine measurement to produce a probability score estimating the likelihood of transplant injury. As a PLA code, 0542U applies only to this specific commercial test and is intended for use by clinical and reference laboratories that perform the assay.
Nationally, tests that noninvasively monitor transplant status are increasingly important for reducing biopsy use and guiding patient management. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical purpose, typical service setting, and payer landscape. The publication summarizes benchmarking and coverage context, highlights policy and coding considerations for PLA tests, and provides clinical context on how combined metabolite profiling with viral PCR and serum creatinine yields a probabilistic assessment of transplant injury risk. Data not available in the input for specific payer policies, reimbursement amounts, taxonomies, ICD‑10 diagnoses, and related codes are noted where relevant.
Billing Code Overview
CPT code 0542U is a Proprietary Laboratory Analyses (PLA) code for the myOLARIS™–KTdx test from Olaris® Inc. The assay analyzes urine for 84 metabolic analytes, integrates patient data, performs real‑time PCR testing for BK virus, and incorporates a serum creatinine measurement to produce a probability score estimating the likelihood of kidney transplant injury.
Service type: Proprietary multi‑analyte urine and molecular diagnostic test for kidney transplant monitoring
Typical site of service: Clinical laboratory (urine collection and laboratory processing with PCR and serum testing performed in a reference lab)
Clinical & Coding Specifications
Clinical Context
A 52-year-old kidney transplant recipient attends a routine post-transplant clinic visit 6 months after transplantation. The patient reports stable symptoms but has a recent low-grade serum creatinine rise on basic labs and intermittent low-level hematuria. The transplant nephrologist orders the myOLARIS™–KTdx test (0542U) to noninvasively assess for allograft injury. The clinic nurse provides a urine collection kit and draws a serum specimen for creatinine and orders real-time PCR testing for BK virus per the test bundle. The urine sample is shipped to the performing laboratory (Olaris® Inc.) under temperature-controlled conditions. Results return as a probabilistic score integrating urinary metabolite profiles (84 metabolites), BK PCR result, and serum creatinine, reported to the nephrology team. The result is used alongside clinical assessment, imaging, and other labs to inform surveillance decisions, such as adjusting immunosuppression, scheduling biopsy, or continued monitoring.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased Procedural Services | Use when the laboratory or associated professional documents a significantly increased complexity in processing or reporting beyond usual test operations (e.g., additional interpretive effort, extensive consultation). |
52 | Reduced Services | Use if the test procedure is partially reduced or not fully performed due to specimen inadequacy or partial testing. |
53 | Discontinued Procedure | Use when testing is started but discontinued for clinical or specimen reasons before completion. |
26 | Professional Component | Use when billing only the professional (interpretive) component separate from the technical component. |
TC | Technical Component | Use when billing only the technical component (laboratory processing) separate from professional interpretation. |
59 | Distinct Procedural Service | Use when another unrelated service is performed on the same day and must be reported separately (for example, a separate molecular test unrelated to 0542U). |
QW | CLIA Waived Test | Not typically applicable to 0542U; include only if a waived portion is performed under waiver rules. |
90 | Reference (Outside) Laboratory | Use when 0542U is performed by an outside independent laboratory and the ordering/performing lab relationship requires reporting. |
TC (duplicate common use) | Technical Component (alternate display) | Use when only the laboratory processing is billed by the performing lab. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 2080P0208X | Transplant Nephrology | Nephrologists specializing in transplant medicine who order and interpret results for graft surveillance. |
| 207RC0000X | Clinical Pathology | Pathology/laboratory medicine specialists involved in test validation and interpretive oversight. |
| 207L00000X | Internal Medicine | General internists or hospitalists managing post-transplant patients who may order the test. |
| 207RP1001X | Infectious Disease | Specialists who interpret BK virus PCR results and manage viral complications. |
| 208000000X | Nephrology | General nephrologists participating in routine post-transplant monitoring. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
T86.12 | Complications of kidney transplant, acute rejection | Direct indication for surveillance testing to detect allograft injury and guide intervention. |
T86.11 | Complications of kidney transplant, chronic rejection | Used when monitoring for progressive graft dysfunction where noninvasive tests inform management. |
N18.9 | Chronic kidney disease, unspecified | Many transplant recipients have underlying CKD; graft monitoring assesses function relative to baseline. |
B34.89 | Other viral infections of unspecified site | May be used in contexts where BK virus infection is suspected and PCR testing is performed as part of 0542U. |
R94.5 | Abnormal results of other cardiovascular function studies; (used for abnormal lab tests) | Used when abnormal noninvasive surveillance findings prompt further evaluation; applicable as a monitoring result context. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
36415 | Collection of venous blood by venipuncture | Performed to obtain serum creatinine used within the 0542U test bundle to assess kidney function. |
81002 | Urinalysis, by dipstick or tablet reagent; non-automated, without microscopy | Initial point-of-care urine assessment often done prior to sending urine for the metabolomic panel. |
87481 | Infectious agent detection by nucleic acid (DNA or RNA); BK virus, real-time PCR | Represents the BK virus real-time PCR component included in the 0542U bundle; sometimes billed separately if not bundled. |
88305 | Level IV surgical pathology, gross and microscopic examination | Kidney allograft biopsy pathology code used when the 0542U result leads to performing a diagnostic biopsy. |
84132 | Creatinine; blood | Laboratory code for serum creatinine measurement that is part of the 0542U composite assessment. |