How To Use CPT Code 0174U

CPT 0174U describes a proprietary laboratory analysis (PLA) code for a specific test called the LC-MS/MS Targeted Proteomic Assay. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of CPT code 0174U.

1. What is CPT Code 0174U?

CPT 0174U is a unique code that represents the LC-MS/MS Targeted Proteomic Assay, a laboratory test performed by OncoOmicDx Laboratory. This test utilizes liquid chromatography (LC) and mass spectrometry (MS) techniques to analyze 30 proteins in formalin-fixed paraffin-embedded (FFPE) tissue samples from solid organ tumors. It also includes a predictive algorithm that assesses the potential benefit of 39 chemotherapy and targeted therapeutic oncology agents for the patient.

2. Official Description

The official description of CPT code 0174U is: ‘Oncology (solid tumor), mass spectrometric 30 protein targets, formalin-fixed paraffin-embedded tissue, prognostic and predictive algorithm reported as likely, unlikely, or uncertain benefit of 39 chemotherapy and targeted therapeutic oncology agents.’

3. Procedure

1. The laboratory analyst processes the FFPE tissue sample and performs targeted analysis using LC-MS/MS to isolate 30 proteins.
2. Liquid chromatography (LC) separates the components of the sample by passing it through a mobile phase, while mass spectrometry (MS) identifies and quantifies the components based on their mass-to-charge ratio.
3. The test includes a predictive algorithm that assesses the potential benefit of 39 chemotherapy and targeted therapeutic oncology agents for the patient.
4. The results of the test are reported as likely, unlikely, or uncertain benefit of the identified agents.

4. Qualifying circumstances

CPT code 0174U is appropriate for patients with solid organ tumors who may benefit from targeted therapies. Clinicians may order this test to determine whether a patient is a candidate for specific chemotherapy and therapeutic oncology agents. It is important to note that this code applies specifically to the LC-MS/MS Targeted Proteomic Assay performed by OncoOmicDx Laboratory.

5. When to use CPT code 0174U

CPT code 0174U should be used when ordering the LC-MS/MS Targeted Proteomic Assay for patients with solid organ tumors. It should not be reported using any other CPT code, as it is a proprietary laboratory analysis (PLA) code specific to this test. Only report one unit of this code for a single specimen analyzed on a single date of service.

6. Documentation requirements

To support a claim for CPT code 0174U, the following documentation is required:

• Documentation of the patient’s diagnosis and the medical necessity for the LC-MS/MS Targeted Proteomic Assay
• Identification of the specific test performed, including the manufacturer or laboratory offering the test
• Date of service and the specimen analyzed
• Results of the test, including the predictive algorithm’s assessment of the benefit of chemotherapy and targeted therapeutic oncology agents
• Signature of the clinician ordering the test

7. Billing guidelines

When billing for CPT code 0174U, ensure that the test is performed by OncoOmicDx Laboratory and that the documentation requirements are met. This code should not be reported with any other CPT code for laboratory/pathology services. Providers may separately report any additional prep work, such as tissue selection or microdissection, using the appropriate CPT codes.

8. Historical information

CPT code 0174U was added to the Current Procedural Terminology system on July 1, 2020. There have been no updates or changes to the code since its addition.

9. Examples

1. A clinician orders the LC-MS/MS Targeted Proteomic Assay for a patient with melanoma to assess the potential benefit of specific chemotherapy and targeted therapeutic oncology agents.
2. A patient with non-small cell lung cancer undergoes the LC-MS/MS Targeted Proteomic Assay to determine whether they may benefit from certain targeted therapies.
3. A clinician requests the test for a patient with breast cancer to evaluate the likelihood of benefit from various chemotherapy and targeted therapeutic oncology agents.
4. The LC-MS/MS Targeted Proteomic Assay is performed on a specimen from a patient with ovarian cancer to guide the selection of appropriate treatment options.
5. A clinician orders the test for a patient with a solid organ tumor to assess the potential benefit of specific chemotherapy and targeted therapeutic oncology agents based on the predictive algorithm’s analysis.
6. The LC-MS/MS Targeted Proteomic Assay is performed on a specimen from a patient with a solid organ tumor to determine the likelihood of benefit from various chemotherapy and targeted therapeutic oncology agents.
7. A patient with melanoma undergoes the test to assess the potential benefit of specific chemotherapy and targeted therapeutic oncology agents based on the predictive algorithm’s analysis.
8. A clinician orders the LC-MS/MS Targeted Proteomic Assay for a patient with non-small cell lung cancer to guide the selection of appropriate treatment options.
9. The test is performed on a specimen from a patient with breast cancer to determine the likelihood of benefit from various chemotherapy and targeted therapeutic oncology agents.
10. A patient with ovarian cancer undergoes the LC-MS/MS Targeted Proteomic Assay to assess the potential benefit of specific chemotherapy and targeted therapeutic oncology agents based on the predictive algorithm’s analysis.