Summary & Overview
CPT 0608U: ALICE Endometrial PCR Test for Chronic Endometritis
CPT code 0608U designates a Proprietary Laboratory Analyses (PLA) test — ALICE (Analysis of Infectious Chronic Endometritis) from Igenomix® — that uses real‑time PCR to detect and quantify 10 bacterial DNA targets from an endometrial biopsy and provides treatment recommendations. As a PLA code, 0608U applies to a single manufacturer-specific assay and is relevant for fertility and gynecologic care where chronic endometritis is evaluated. Nationally, molecular diagnostic PLA codes influence laboratory billing policy, prior authorization practices, and coverage determinations because they represent unique tests with limited code interchangeability.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines how payers approach coverage of proprietary molecular assays, common documentation and reporting expectations, and the clinical context in which 0608U is ordered.
Readers will learn: the clinical purpose of the test, typical sites of service and the laboratory service model, payer landscape coverage considerations, and where to find relevant billing descriptors and clinical context for use. Data not available in the input are noted where applicable, and the content focuses on national implications for coding and clinical use rather than state-level policy.
Billing Code Overview
CPT code 0608U is a Proprietary Laboratory Analyses (PLA) code for ALICE (Analysis of Infectious Chronic Endometritis) from Igenomix®. The test uses real–time polymerase chain reaction (PCR) to analyze an endometrial biopsy for 10 bacterial DNA targets associated with chronic endometritis. Results include quantified bacterial levels and treatment recommendations.
Service type: Laboratory diagnostic molecular test using real-time PCR to detect and quantify bacterial DNA in an endometrial biopsy.
Typical site of service: Clinical laboratory or reference laboratory performing specialized molecular diagnostic testing.
Clinical & Coding Specifications
Clinical Context
A 34-year-old woman with a history of two failed in vitro fertilization (IVF) cycles and persistent abnormal uterine bleeding is evaluated for possible chronic endometritis as a contributor to implantation failure. After hysteroscopic inspection and endometrial biopsy is performed in the outpatient gynecology clinic or ambulatory surgical center, a sterile endometrial tissue sample is sent to Igenomix® for the ALICE test. The laboratory performs real-time PCR targeting 10 bacterial DNA targets associated with chronic endometritis, quantifies bacterial load, and returns a report with bacterial levels and suggested antimicrobial treatment options. Typical workflow: patient seen by reproductive endocrinologist or gynecologist → informed consent and endometrial biopsy obtained during mid-luteal or clinically appropriate window → specimen labeled and shipped per manufacturer instructions → laboratory performs PLA test billed with 0608U → results reviewed by ordering clinician to guide targeted therapy and timing of subsequent fertility procedures.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing separately for the physician interpretation of the laboratory result if applicable (facility bills technical component). |