Summary & Overview
CPT 0607U: Endometrial Microbiome Metagenomic Analysis (EMMA)
CPT code 0607U designates EMMA (Endometrial Microbiome Metagenomic Analysis), a proprietary molecular diagnostic test from Igenomix® that uses real‑time PCR to detect and quantify 31 bacterial species in DNA from an endometrial biopsy. As a PLA code, 0607U applies to a single manufacturer’s test, which directly links the billing code to a unique laboratory service. Nationally, such PLA codes matter because they standardize billing for novel, lab‑specific assays and influence coverage, coding clarity, and laboratory reporting practices.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the test purpose and clinical context, payer coverage considerations, where the service is typically furnished, and what benchmarks and policy topics commonly accompany PLA molecular diagnostics — including coding specificity, billing practices, and implications for laboratory workflows. The publication outlines available information on service configuration and sites of care and identifies areas where payer policy language and coverage criteria are typically relevant for adoption and reimbursement decisions.
Data not available in the input: common modifiers, associated taxonomies, ICD‑10 diagnoses, related codes, and detailed payer policy language.
Billing Code Overview
CPT code 0607U is a Proprietary Laboratory Analyses (PLA) code that applies only to a single, manufacturer‑specific laboratory test. Report 0607U only for EMMA (Endometrial Microbiome Metagenomic Analysis) from Igenomix®. The test analyzes DNA from an endometrial biopsy using real‑time polymerase chain reaction (PCR) to detect and quantify 31 bacterial species and provides targeted treatment recommendations based on the bacterial profile.
Service Type: Molecular diagnostic microbiome analysis of endometrial tissue
Typical Site of Service: Clinical laboratory or specialized molecular diagnostics laboratory; specimen collected in an outpatient clinic or ambulatory procedure setting (endometrial biopsy)
Clinical & Coding Specifications
Clinical Context
A 34-year-old woman with a history of recurrent implantation failure after in vitro fertilization (IVF) and recurrent early pregnancy loss presents to a fertility clinic for evaluation. After counseling, an endometrial biopsy is obtained during the mid-luteal phase in a sterile outpatient procedure. The specimen is submitted to Igenomix® for the EMMA (Endometrial Microbiome Metagenomic Analysis) test, reported under 0607U. EMMA uses targeted real-time PCR to detect and quantify 31 bacterial species from endometrial tissue, generating a microbiome profile and providing targeted treatment recommendations. Typical workflow steps include scheduling the biopsy with a reproductive endocrinology or maternal-fetal medicine provider, obtaining informed consent, performing the endometrial sampling in an outpatient procedure room, packaging and shipping the specimen per the laboratory’s instructions, receiving the molecular report into the electronic health record, and integrating the results into the infertility treatment plan.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the physician interpretation is billed separately from the laboratory component (rare for PLA codes). |
TC |