Summary & Overview
CPT 84030: Phenylalanine Quantitative Assay for Phenylketonuria
CPT code 84030 represents a quantitative laboratory assay for phenylalanine, most often performed on filter paper blood spot cards or blood plasma. This test is a cornerstone of newborn metabolic screening and clinical monitoring for phenylketonuria (PKU), a rare genetic condition that can lead to neurodevelopmental harm if untreated. Nationally, phenylalanine measurement supports early detection programs and chronic disease management pathways that reduce long-term morbidity.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for PKU screening and monitoring, typical service settings, and the operational role of the assay. The publication summarizes common billing modifiers and practical coding considerations where available, and outlines what stakeholders should know about reimbursement positioning and payer coverage patterns in a national context.
This resource is intended to help clinical coders, laboratory managers, and policy analysts understand the clinical purpose of CPT code 84030, how it fits into newborn screening and metabolic disorder workflows, and which payers are most relevant for coverage considerations. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 84030 describes a laboratory assay that determines the presence and concentration of the amino acid phenylalanine. The test is most commonly performed on a filter paper blood spot card or a blood plasma sample and is used to detect and monitor phenylketonuria (PKU), a rare inherited metabolic disorder in which phenylalanine accumulates abnormally in the body.
Service Type: Laboratory diagnostic test — quantitative amino acid analysis
Typical Site of Service: Clinical laboratory or neonatal screening program using blood spot cards, with specimens collected in outpatient clinics, hospitals, or public health settings.
Clinical & Coding Specifications
Clinical Context
A newborn infant born at a community hospital undergoes routine newborn metabolic screening. A heel-stick blood sample is collected onto a filter paper blood spot card within 24–48 hours of life and sent to the hospital laboratory. The lab analyst performs quantitative measurement of phenylalanine using a validated assay to screen for phenylketonuria (PKU) and other hyperphenylalaninemias. Results that exceed institutional cutoff values trigger reflex testing, confirmatory plasma phenylalanine measurement, and notification of the newborn nursery, pediatrician, and the state newborn screening program. For an older child or adult with developmental delay or suspected metabolic disorder, a clinician orders a plasma phenylalanine level; a phlebotomist obtains a venous blood sample, and the laboratory performs the 84030 assay to quantify phenylalanine concentration. Typical workflow steps include specimen collection, labeling and accessioning, analytical testing, result validation by a laboratory scientist, and result reporting to the ordering clinician and public health authorities when required.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation or oversight by a qualified laboratory director or pathologist separate from the technical component. |