How To Use CPT Code 0131U

CPT 0131U describes a targeted mRNA sequence analysis panel of 13 genes for hereditary breast cancer-related disorders. 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 0131U?

CPT 0131U can be used to describe a targeted mRNA sequence analysis panel of 13 genes for hereditary breast cancer-related disorders. This code is used in conjunction with other codes for genomic sequencing procedures to improve variant classification and better manage cancers associated with these genes.

2. Official Description

The official description of CPT code 0131U is: ‘Hereditary breast cancer-related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer), targeted mRNA sequence analysis panel (13 genes) (List separately in addition to code for primary procedure).’ This code should be reported separately in addition to the primary procedure code.

3. Procedure

1. The lab analyst performs targeted mRNA sequence analysis of 13 genes using a high throughput, qualitative, and quantitative sequence analysis technology.
2. This analysis allows for better classification of splicing variants and improves the identification of genes implicated in hereditary breast cancer-related disorders.
3. The test is ordered by clinicians as an adjunct to DNA genetic testing to determine the impact of variants on clinical outcomes and guide medical management.
4. The test results help identify at-risk individuals, determine the need for earlier or more frequent imaging and testing, and tailor treatments for hereditary cancer-related disorders.

4. Qualifying circumstances

Patients eligible for CPT 0131U are those with hereditary breast cancer-related disorders, including hereditary breast cancer, hereditary ovarian cancer, and hereditary endometrial cancer. The test is performed on germline or neoplastic specimens requested by the clinical lab offering the test. It is used to improve variant classification and guide medical management for these disorders.

5. When to use CPT code 0131U

CPT code 0131U should be used when performing a targeted mRNA sequence analysis panel of 13 genes for hereditary breast cancer-related disorders. It should be reported in addition to the primary procedure code for genomic sequencing procedures related to these disorders.

6. Documentation requirements

To support a claim for CPT code 0131U, documentation should include:

• Indication for the test and the need for improved variant classification
• Details of the targeted mRNA sequence analysis panel of 13 genes
• Date of service and specific results of the analysis
• Clinical implications of the test results and any recommended medical management
• Signature of the lab analyst performing the test

7. Billing guidelines

When billing for CPT code 0131U, ensure that the test is performed by a clinical lab offering the RNAinsight™ for BreastNext® test from Ambry Genetics. Report this code only in addition to the appropriate primary procedure code, such as 81162 for BRCA1 and BRCA2 full gene analysis and duplication/deletion analysis, or 81432 or 0102U for genomic sequencing of 10 or 17 genes related to hereditary breast cancer-related disorders, respectively. Check with the appropriate payer regarding separate reimbursement for specimen collection.

8. Historical information

CPT code 0131U was added to the Current Procedural Terminology system on October 1, 2019. There have been no updates to the code since its addition.

9. Examples

1. A lab performing targeted mRNA sequence analysis of 13 genes for a patient with hereditary breast cancer.
2. A clinician ordering CPT code 0131U in addition to genomic sequencing procedures to better classify variants and guide medical management for a patient with hereditary ovarian cancer.
3. A lab analyst using CloneSeq™ technology to perform targeted mRNA sequence analysis of 13 genes for a patient with hereditary endometrial cancer.
4. A clinician ordering the RNAinsight™ for BreastNext® test from Ambry Genetics to improve variant classification and manage hereditary breast cancer-related disorders in a patient.
5. A lab performing targeted mRNA sequence analysis of 13 genes for a patient with a family history of hereditary breast cancer.
6. A clinician ordering CPT code 0131U to identify at-risk individuals and guide medical management for a patient with hereditary ovarian cancer.
7. A lab analyst using high throughput sequence analysis technology to perform targeted mRNA sequence analysis of 13 genes for a patient with hereditary endometrial cancer.
8. A clinician ordering the RNAinsight™ for BreastNext® test from Ambry Genetics to better classify variants and manage hereditary breast cancer-related disorders in a patient with a family history of breast cancer.
9. A lab performing targeted mRNA sequence analysis of 13 genes for a patient with a suspected hereditary breast cancer-related disorder.
10. A clinician ordering CPT code 0131U to improve variant classification and guide medical management for a patient with hereditary endometrial cancer.