How To Use CPT Code 0067U

CPT 0067U describes a proprietary laboratory analysis (PLA) code for a specific biomarker assay called BBDRisk Dx™, developed by Silbiotech, Inc. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of CPT code 0067U.

1. What is CPT Code 0067U?

CPT 0067U is a unique PLA code that represents the BBDRisk Dx™ biomarker assay. This assay is designed to predict the likelihood of breast cancer development in women with specific precancerous breast tumors. It analyzes the protein expression levels of four biomarkers (matrix metalloproteinase-1 [MMP-1], carcinoembryonic antigen-related cell adhesion molecule 6 [CEACAM6], hyaluronoglucosaminidase [HYAL1], highly expressed in cancer protein [HEC1]) in formalin-fixed paraffin-embedded precancerous breast tissue. The results are reported as a carcinoma risk score based on an algorithmic analysis.

2. Official Description

The official description of CPT code 0067U is: ‘Oncology (breast), immunohistochemistry, protein expression profiling of 4 biomarkers (MMP-1, CEACAM6, HYAL1, HEC1), formalin-fixed paraffin-embedded precancerous breast tissue, algorithm reported as carcinoma risk score.’

3. Procedure

1. The laboratory analyst selects formalin-fixed paraffin-embedded precancerous breast tissue for analysis.
2. An immunohistochemistry assay is performed to measure the protein expression levels of MMP-1, CEACAM6, HYAL1, and HEC1.
3. The test results, along with other patient data, are subjected to an algorithmic analysis using a proprietary database.
4. A carcinoma risk score is generated based on the algorithmic analysis, categorizing the patient as having low, intermediate, or high risk of developing breast cancer.

4. Qualifying circumstances

CPT code 0067U is applicable for women who have been diagnosed with specific precancerous breast tumors, such as hyperplasia (atypical or typical), sclerosing adenosis, and/or papillomas. The test is used to evaluate the patient’s risk of developing breast cancer. It is important to note that this code should only be used for the BBDRisk Dx™ biomarker assay from Silbiotech, Inc.

5. When to use CPT code 0067U

CPT code 0067U should be used when a clinician orders the BBDRisk Dx™ biomarker assay for women with specific precancerous breast tumors to assess their risk of developing breast cancer. It is not appropriate to use this code for other breast oncology MAAA tests, such as 0009U, 0045U, 81519, 81520, or 81521.

6. Documentation requirements

To support a claim for CPT code 0067U, the following documentation is required:

• Documentation of the patient’s diagnosis of specific precancerous breast tumors
• Documentation of the use of the BBDRisk Dx™ biomarker assay from Silbiotech, Inc.
• Date of service and the specific formalin-fixed paraffin-embedded precancerous breast tissue analyzed
• Results of the protein expression profiling for MMP-1, CEACAM6, HYAL1, and HEC1
• Carcinoma risk score generated by the algorithmic analysis

7. Billing guidelines

When billing for CPT code 0067U, ensure that the BBDRisk Dx™ biomarker assay from Silbiotech, Inc. is being reported. This code should not be reported with any other CPT code for laboratory/pathology tests. It is important to report one unit of this code for each individual specimen analyzed on a single date of service.

8. Historical information

CPT code 0067U was added to the Current Procedural Terminology system on October 1, 2018. There have been no updates or changes to the code since its addition.

9. Examples

1. A woman with a diagnosis of atypical hyperplasia undergoes the BBDRisk Dx™ biomarker assay to assess her risk of developing breast cancer.
2. A patient with sclerosing adenosis undergoes the BBDRisk Dx™ biomarker assay to determine her risk of developing breast cancer.
3. A woman with a diagnosis of papilloma undergoes the BBDRisk Dx™ biomarker assay to evaluate her risk of developing breast cancer.
4. A patient with typical hyperplasia undergoes the BBDRisk Dx™ biomarker assay to assess her risk of developing breast cancer.
5. A woman with a diagnosis of atypical hyperplasia and sclerosing adenosis undergoes the BBDRisk Dx™ biomarker assay to determine her risk of developing breast cancer.
6. A patient with atypical hyperplasia and papilloma undergoes the BBDRisk Dx™ biomarker assay to evaluate her risk of developing breast cancer.
7. A woman with a diagnosis of sclerosing adenosis and papilloma undergoes the BBDRisk Dx™ biomarker assay to assess her risk of developing breast cancer.
8. A patient with atypical hyperplasia, sclerosing adenosis, and papilloma undergoes the BBDRisk Dx™ biomarker assay to determine her risk of developing breast cancer.
9. A woman with a diagnosis of atypical hyperplasia and typical hyperplasia undergoes the BBDRisk Dx™ biomarker assay to evaluate her risk of developing breast cancer.
10. A patient with sclerosing adenosis and papilloma undergoes the BBDRisk Dx™ biomarker assay to assess her risk of developing breast cancer.