CodeMap®

PLA Code	Description	Test Name	Lab Name	Manufacturer	Effective Date
0001U	Red blood cell antigen typing, DNA, human erythrocyte antigen gene analysis of 35 antigens from 11 blood groups, utilizing whole blood, common RBC alleles reported	PreciseTypeÆ HEA Test	Immucor, Inc.	Immucor, Inc.	02/01/2017
0002U	Oncology (colorectal), quantitative assessment of three urine metabolites (ascorbic acid, succinic acid and carnitine) by liquid chromatography with tandem mass spectrometry (LC-MS/MS) using multiple reaction monitoring acquisition, algorithm reported as likelihood of adenomatous polyps	PolypDXô	Atlantic Diagnostic Laboratories, LLC	Metabolomic Technologies Inc.	02/01/2017
0003U	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	Overa (OVA1 Next Generation)	Aspira Labs, Inc.	Vermillion, Inc.	02/01/2017
0005U	Oncology (prostate) gene expression profile by real-time RT-PCR of 3 genes (ERG, PCA3, and SPDEF), urine, algorithm reported as risk score	ExosomeDxÆProstate (IntelliScore)	Exosome Diagnostics, Inc.	Exosome Diagnostics, Inc.	05/01/2017
0006U	Prescription drug monitoring, 120 or more drugs and substances, definitive tandem mass spectrometry with chromatography, urine, qualitative report of presence (including quantitative levels, when detected) or absence of each drug or substance with description and severity of potential interactions, with identified substances, per date of service	Aegis Drug-Drug Interaction Test	Aegis Sciences Corporation	Aegis Sciences Corporation	08/01/2017
0007U	Drug test(s), presumptive, with definitive confirmation of positive results, any number of drug classes, urine, includes specimen verification including DNA authentication in comparison to buccal DNA, per date of service	ToxProtect	Genotox Laboratories LTD	Genotox Laboratories LTD	08/01/2017
0008U	Helicobacter pylori detection and antibiotic resistance, DNA, 16S and 23S rRNA, gyrA, pbp1, rdxA and rpoB, next generation sequencing, formalin-fixed paraffin-embedded or fresh tissue, predictive, reported as positive or negative for resistance to clarithromycin, fluoroquinolones, metronidazole, amoxicillin, tetracycline and rifabutin	AmHPR Helicobacter pylori Antibiotic Resistance Next Generation Sequencing Panel	American Molecular Laboratories, Inc.	American Molecular Laboratories, Inc.	08/01/2017
0009U	Oncology (breast cancer), ERBB2 (HER2) copy number by FISH, tumor cells from formalin-fixed paraffin-embedded tissue isolated using image-based dielectrophoresis (DEP) sorting, reported as ERBB2 gene amplified or non-amplified	DEPArrayTM HER2	PacificDx	PacificDx	08/01/2017
0010U	Infectious disease (bacterial), strain typing by whole genome sequencing, phylogenetic-based report of strain relatedness, per submitted isolate	Bacterial StrainTyping by Whole Genome Sequencing (WGS)	Mayo Clinic	Mayo Clinic	08/01/2017
0011U	Prescription drug monitoring, evaluation of drugs present by LC-MS/MS, using oral fluid, reported as a comparison to an estimated steady-state range, per date of service including all drug compounds and metabolites	Cordant CORE®	Cordant Health Solutions	Cordant Health Solutions	08/01/2017
0012U	Germline disorders, gene rearrangement detection by whole genome next-generation sequencing, DNA, whole blood, report of specific gene rearrangement(s)	MatePair Targeted Rearrangements, Congenital	Mayo Clinic	Mayo Clinic	08/01/2017
0013U	Oncology (solid organ neoplasia), gene rearrangement detection by whole genome next-generation sequencing, DNA, fresh or frozen tissue or cells, report of specific gene rearrangement(s)	MatePair Targeted Rearrangements, Oncology,	Mayo Clinic	Mayo Clinic	08/01/2017
0014U	Hematology (hematolymphoid neoplasia), gene rearrangement detection by whole genome next-generation sequencing, DNA, whole blood or bone marrow, report of specific gene rearrangement(s)	MatePair Targeted Rearrangements, Hematologic	Mayo Clinic	Mayo Clinic	08/01/2017
0016U	Oncology (hematolymphoid neoplasia), RNA, BCR/ABL1 major and minor breakpoint fusion transcripts, quantitative PCR amplification, blood or bone marrow, report of fusion not detected or detected with quantitation	BCR-ABL1 major and minor breakpoint fusion transcripts	University of Iowa, Department of Pathology	Asuragen	08/01/2017
0017U	Oncology (hematolymphoid neoplasia), JAK2 mutation, DNA, PCR amplification of exons 12-14 and sequence analysis, blood or bone marrow, report of JAK2 mutation not detected or detected	JAK2 Mutation	University of Iowa, Department of Pathology	University of Iowa, Department of Pathology	08/01/2017
0018U	Oncology (thyroid), microRNA profiling by RT-PCR of 10 microRNA sequences, utilizing fine needle aspirate, algorithm reported as a positive or negative result for moderate to high risk of malignancy	ThyraMIR	Interpace Diagnostics	Interpace Diagnostics	10/01/2017
0019U	Oncology, RNA, gene expression by whole transcriptome sequencing, formalin-fixed paraffin embedded tissue or fresh frozen tissue, predictive algorithm reported as potential targets for therapeutic agents	OncoTarget/OncoTreat	Columbia University Department of Pathology and Cell Biology	Darwin Health	10/01/2017
0020U	Drug test(s), presumptive, with definitive confirmation of positive results, any number of drug classes, urine, with specimen verification including DNA authentication in comparison to buccal DNA, per date of service	ToxLok	InSource Diagnostics	InSource Diagnostics	10/01/2017
0021U	Oncology (prostate), detection of 8 autoantibodies (ARF 6, NKX3-1, 5í-UTR-BMI1, CEP 164, 3í-UTR-Ropporin, Desmocollin, AURKAIP-1, CSNK2A2), multiplexed immunoassay and flow cytometry serum, algorithm reported as risk score	ApifinyÆ	Armune BioScience Inc.	Armune BioScience Inc.	10/01/2017
0022U	Targeted genomic sequence analysis panel, non-small cell lung neoplasia, DNA and RNA analysis, 23 genes, interrogation for sequence variants and rearrangements, reported as presence/absence of variants and associated therapy(ies) to consider	Oncomineô Dx Target Test	Thermo Fisher Scientific	Thermo Fisher Scientific	10/01/2017
0023U	Oncology (acute myelogenous leukemia), DNA, genotyping of internal tandem duplication, p.D835, p.I836, using mononuclear cells, reported as detection or non-detection of FLT3 mutation and indication for or against the use of midostaurin	LeukoStratÆ CDx FLT3 Mutation Assay	LabPMM LLC, an Invivoscribe Technologies, Inc. company	Invivoscribe Technologies, Inc.	10/01/2017
0024U	Glycosylated acute phase proteins (GlycA), nuclear magnetic resonance spectroscopy, quantitative	GlycA	Laboratory Corporation of America	Laboratory Corporation of America	01/01/2018
0025U	Tenofovir, by liquid chromatography with tandem mass spectrometry (LC-MS/MS), urine, quantitative	UrSure Tenofovir Quantification Test	Synergy Medical Laboratories	UrSure Inc.	01/01/2018
0026U	Oncology (thyroid), DNA and mRNA of 112 genes, next-generation sequencing, fine needle aspirate of thyroid nodule, algorithmic analysis reported as a categorical result ("Positive, high probability of malignancy" or "Negative, low probability of malignancy")	Thyroseq Genomic Classifier	CBLPath, Inc.	University of Pittsburgh Medical Center	01/01/2018
0027U	JAK2 (Janus kinase 2) (eg, myeloproliferative disorder) gene analysis, targeted sequence analysis exons 12-15	JAK2 Exons 12 to 15 Sequencing	Mayo Clinic	Mayo Clinic	01/01/2018
0028U	CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism) gene analysis, copy number variants, common variants with reflex to targeted sequence analysis	CYP2D6 Genotype Cascade	Mayo Clinic	Mayo Clinic	01/01/2018
0029U	Drug metabolism (adverse drug reactions and drug response), targeted sequence analysis (ie, CYP1A2, CYP2C19, CYP2C9, CYP2D6, CYP3A4, CYP3A5, CYP4F2, SLCO1B1, VKORC1 and rs12777823)	Focused Pharmacogenomics Panel	Mayo Clinic	Mayo Clinic	01/01/2018
0030U	Drug metabolism (warfarin drug response), targeted sequence analysis (ie, CYP2C9, CYP4F2, VKORC1, rs12777823)	Warfarin Response Genotype	Mayo Clinic	Mayo Clinic	01/01/2018
0031U	CYP1A2 (cytochrome P450 family 1, subfamily A, member 2)(eg, drug metabolism) gene analysis, common variants (ie, 1F, 1K, 6, 7)	Cytochrome P450 1A2 Genotype	Mayo Clinic	Mayo Clinic	01/01/2018
0032U	COMT (catechol-O-methyltransferase)(drug metabolism) gene analysis, c.472G>A (rs4680) variant	Catechol-O-Methyltransferase (COMT) Genotype	Mayo Clinic	Mayo Clinic	01/01/2018
0033U	HTR2A (5-hydroxytryptamine receptor 2A), HTR2C (5-hydroxytryptamine receptor 2C) (eg, citalopram metabolism) gene analysis, common variants (ie, HTR2A rs7997012 [c.614-2211T>C], HTR2C rs3813929 [c.-759C>T] and rs1414334 [c.551-3008C>G])	Serotonin Receptor Genotype (HTR2A and HTR2C)	Mayo Clinic	Mayo Clinic	01/01/2018
0034U	TPMT (thiopurine S-methyltransferase), NUDT15 (nudix hydroxylase 15)(eg, thiopurine metabolism) gene analysis, common variants (ie, TPMT 2, 3A, 3B, 3C, 4, 5, 6, 8, 12; NUDT15 3, 4, 5)	Thiopurine Methyltransferase (TPMT) and Nudix Hydrolase (NUDT15) Genotyping	Mayo Clinic	Mayo Clinic	01/01/2018
0035U	Neurology (prion disease), cerebrospinal fluid, detection of prion protein by quaking-induced conformational conversion, qualitative	Real-time quaking-induced conversion for prion detection (RT-QuIC)	National Prion Disease Pathology Surveillance Center	National Prion Disease Pathology Surveillance Center	04/01/2018
0036U	Exome (ie, somatic mutations); paired formalin fixed paraffin embedded tumor tissue and normal specimen, sequence analyses	EXaCT-1 Whole Exome Testing	Lab of Oncology-Molecular Detection	Weill Cornell Medicine - Clinical Genomics Laboratory	04/01/2018
0037U	Targeted genomic sequence analysis, solid organ neoplasm, DNA analysis of 324 genes, interrogation for sequence variants, gene copy number amplifications, gene rearrangements, microsatellite instability and tumor mutational burden	FoundationOne CDxô (F1CDx)	Foundation Medicine, Inc.	Foundation Medicine, Inc.	04/01/2018
0038U	Vitamin D, 25 hydroxy D2 and D3, by LC-MS/MS, serum microsample, quantitative	SensievaTM Droplet 25OH Vitamin D2/D3 Microvolume LC/MS Assay	InSource Diagnostics	InSource Diagnostics	04/01/2018
0039U	Deoxyribonucleic acid (DNA) antibody; double stranded, high avidity	Anti-dsDNA, High Salt/Avidity	University of Washington, Department of Laboratory Medicine	Bio-Rad	04/01/2018
0040U	BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis, major breakpoint, quantitative	MRDx BCR-ABL Test	MolecularMD	MolecularMD	04/01/2018
0041U	Borrelia burgdorferi, antibody detection of 5 recombinant protein groups, by immunoblot, IgM	Lyme ImmunoBlot IgM	IGeneX Inc	ID-FISH Technology Inc. (ASR) (Lyme ImmunoBlot IgM Strips Only)	04/01/2018
0042U	Borrelia burgdorferi, antibody detection of 12 recombinant protein groups, by immunoblot, IgG	Lyme ImmunoBlots IgG	IGeneX Inc	ID-FISH Technology Inc. (ASR) (Lyme ImmunoBlot IgG Strips Only)	04/01/2018
0043U	Tick-Borne Relapsing Fever Borrelia group, antibody detection to 4 recombinant protein groups, by immunoblot, IgM	Tick-Borne Relapsing Fever Borrelia (TBRF) ImmunoBlots IgM Test	IGeneX Inc	ID-FISH Technology Inc. (Provides TBRF ImmunoBlot IgM Strips).	04/01/2018
0044U	Tick-Borne Relapsing Fever Borrelia group, antibody detection to 4 recombinant protein groups, by immunoblot,	Tick-Borne Relapsing Fever Borrelia (TBRF) ImmunoBlots IgG Test	IGeneX Inc	ID-FISH Technology Inc. (Provides TBRF ImmunoBlot IgG Strips)	04/01/2018

CodeMap® is a Registered Trademark of Wheaton Partners, LLC.