How To Use CPT Code 0003U

CPT 0003U describes a proprietary laboratory analysis (PLA) code for oncology (ovarian) biochemical assays of five proteins. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 0003U?

CPT 0003U can be used to describe a specific lab test performed by Aspira Labs, Inc., Vermillion, Inc. It is a biochemical assay of a serum specimen to detect the presence of five biomarker proteins for ovarian cancer. The test includes algorithmic analysis using patient data and lab test results to determine the patient’s risk for ovarian cancer.

2. Official Description

The official description of CPT code 0003U is: ‘Oncology (ovarian) biochemical assays of five proteins (apolipoprotein A-1, CA 125 II, follicle stimulating hormone, human epididymis protein 4, transferrin), utilizing serum, algorithm reported as a likelihood score.’

3. Procedure

1. The lab analyst performs a series of technical steps to test the patient’s serum for the presence of five biomarker proteins using an immunoassay method.
2. The test involves reacting the specimen with test antibodies, incubating the mixture, adding microparticles to bind the complexes to an electrode, and applying an electric charge to initiate luminescence.
3. The analyst reports qualitative results, indicating the presence or absence of the biomarkers in the specimen.
4. A proprietary algorithm is then used to combine the biomarker results with clinical assessment into a single numerical risk score for ovarian cancer.

4. Qualifying circumstances

CPT 0003U is ordered by clinicians to determine a patient’s risk for having ovarian cancer. It is not intended as a screening test or a stand-alone diagnostic assay. The test analyzes the presence of five specific biomarker proteins associated with ovarian cancer: apolipoprotein A-1, CA 125 II, follicle stimulating hormone, human epididymis protein 4, and transferrin.

5. When to use CPT code 0003U

CPT code 0003U should be used when a clinician orders the specific lab test described above to assess a patient’s risk for ovarian cancer. It should not be used as a general screening test or as a stand-alone diagnostic assay.

6. Documentation requirements

To support a claim for CPT 0003U, the documentation should include:

• The specific lab test ordered (Oncology (ovarian) biochemical assays of five proteins)
• The date of service
• The patient’s serum specimen analyzed
• The qualitative results indicating the presence or absence of the biomarkers
• The proprietary algorithmic analysis and the resulting numerical risk score

7. Billing guidelines

When billing for CPT 0003U, ensure that the test is performed by Aspira Labs, Inc., Vermillion, Inc. and that all necessary documentation is provided. This code should not be reported with any other CPT code. It is important to check with the appropriate payer regarding reimbursement for specimen collection.

8. Historical information

CPT 0003U, a proprietary laboratory analysis (PLA) code, was added to the CPT code set on February 1, 2017. There have been no updates to the code since its addition.

9. Examples

1. A clinician orders CPT code 0003U to assess a patient’s risk for ovarian cancer based on the analysis of five specific biomarker proteins.
2. A patient with a family history of ovarian cancer undergoes CPT code 0003U to determine their individual risk for the disease.
3. A postmenopausal woman presents with symptoms suggestive of ovarian cancer, and the clinician orders CPT code 0003U to aid in the diagnosis.
4. A patient with a known ovarian mass undergoes CPT code 0003U to assess the likelihood of malignancy.
5. A clinician uses CPT code 0003U to monitor the response to ovarian cancer treatment by tracking changes in the biomarker protein levels.
6. A patient with a high-risk genetic mutation undergoes CPT code 0003U as part of their regular surveillance for ovarian cancer.
7. A clinician orders CPT code 0003U to assess the risk of ovarian cancer recurrence in a patient who has completed treatment.
8. A woman with a complex ovarian cyst undergoes CPT code 0003U to aid in the decision-making process regarding surgical intervention.
9. A patient with a history of breast cancer undergoes CPT code 0003U to assess their risk for developing ovarian cancer.
10. A clinician orders CPT code 0003U to evaluate a patient with persistent pelvic pain and suspected ovarian pathology.