How To Use CPT Code 0090U

CPT 0090U describes a specific proprietary laboratory analysis (PLA) test called myPath® Melanoma. This test is performed by Castle Biosciences Inc. and utilizes reverse transcriptase-polymerase chain reaction (RT-PCR) mRNA gene expression profiling technology to analyze a biopsy specimen of a suspicious skin lesion for 23 genes. The test results are reported as benign, intermediate, or malignant, providing valuable information for the diagnosis and treatment of cutaneous melanoma.

1. What is CPT Code 0090U?

CPT 0090U is a unique code that represents the myPath® Melanoma test, a proprietary laboratory analysis (PLA) test performed by Castle Biosciences Inc. This test uses reverse transcriptase-polymerase chain reaction (RT-PCR) mRNA gene expression profiling technology to analyze a biopsy specimen of a suspicious skin lesion for 23 genes. The test results are reported as benign, intermediate, or malignant, providing important information for the diagnosis and management of cutaneous melanoma.

2. Official Description

The official description of CPT code 0090U is: ‘Oncology (cutaneous melanoma), mRNA gene expression profiling by RT-PCR of 23 genes (14 content and 9 housekeeping), utilizing formalin-fixed paraffin-embedded (FFPE) tissue, algorithm reported as a categorical result (i.e., benign, intermediate, malignant).’ This code specifically applies to the myPath® Melanoma test offered by Castle Biosciences Inc.

3. Procedure

1. The myPath® Melanoma test begins with the collection of a biopsy specimen from a suspicious skin lesion.
2. The specimen is then processed and prepared as a formalin-fixed paraffin-embedded (FFPE) tissue sample.
3. The lab analyst performs reverse transcriptase-polymerase chain reaction (RT-PCR) mRNA gene expression profiling on the FFPE tissue sample.
4. This profiling involves quantitatively measuring the activity of 23 genes, including 14 content genes and 9 housekeeping genes.
5. The gene expression data is analyzed using an algorithm to determine the categorical result of the test, which can be benign, intermediate, or malignant.
6. The final test report is generated and provided to the healthcare provider for further evaluation and treatment decision-making.

4. Qualifying circumstances

The myPath® Melanoma test is indicated for patients with suspicious skin lesions that are potentially indicative of cutaneous melanoma. This test is specifically designed to provide additional information beyond traditional histopathology to aid in the diagnosis and management of cutaneous melanoma. It is important to note that CPT code 0090U applies only to the myPath® Melanoma test performed by Castle Biosciences Inc.

5. When to use CPT code 0090U

CPT code 0090U should be used when a healthcare provider orders the myPath® Melanoma test from Castle Biosciences Inc. for a patient with a suspicious skin lesion. This test is particularly useful when additional information is needed to determine the likelihood of cutaneous melanoma and guide treatment decisions. It is important to ensure that the test is performed by Castle Biosciences Inc. and that the results are reported as a categorical result (benign, intermediate, or malignant).

6. Documentation requirements

To support a claim for CPT code 0090U, the healthcare provider should ensure that the following documentation is included:

• Indication for the myPath® Melanoma test, such as a suspicious skin lesion
• Documentation of the biopsy specimen used for the test
• Confirmation that the test was performed by Castle Biosciences Inc.
• Report of the categorical result (benign, intermediate, or malignant)

7. Billing guidelines

When billing for CPT code 0090U, it is important to ensure that the test is performed by Castle Biosciences Inc. and that the results are reported as a categorical result. This code should not be reported using any other CPT code. It is also important to follow any additional guidelines provided by the payer regarding billing and reimbursement for this specific test.

8. Historical information

CPT code 0090U was initially introduced on January 1, 2022. There have been no updates or changes to the code since its introduction.

9. Examples

1. A dermatologist orders the myPath® Melanoma test for a patient with a suspicious skin lesion to determine the likelihood of cutaneous melanoma.
2. An oncologist requests the myPath® Melanoma test for a patient with a complex case of melanoma to guide treatment decisions.
3. A plastic surgeon utilizes the myPath® Melanoma test to assess the malignancy risk of a suspicious skin lesion before performing a surgical procedure.
4. A primary care physician orders the myPath® Melanoma test for a patient with multiple atypical moles to evaluate the risk of cutaneous melanoma.
5. A dermatopathologist recommends the myPath® Melanoma test for a patient with a challenging histopathological diagnosis to obtain additional information for accurate classification.
6. An oncology nurse educates a patient about the myPath® Melanoma test and assists in the collection of the biopsy specimen for analysis.
7. A healthcare administrator ensures that the myPath® Melanoma test is properly documented and billed according to the specific guidelines provided by the payer.
8. A medical coder accurately assigns CPT code 0090U for the myPath® Melanoma test performed by Castle Biosciences Inc. for a patient with a suspicious skin lesion.
9. A laboratory technician follows the established protocols and quality control measures during the processing and analysis of the biopsy specimen for the myPath® Melanoma test.
10. A healthcare provider discusses the results of the myPath® Melanoma test with a patient, providing them with valuable information for their treatment plan and prognosis.