CCSD Code 0005G (Single Gene Test EGFR, blood): UK billing guide

Key Takeaways

CCSD Code 0005G is the Single Gene Test EGFR (blood) — a diagnostic pathology test in Chapter 34 (Pathology) of the UK private healthcare CCSD Schedule, not a surgical procedure. It replaces the older code 4198B.

It is a molecular pathology blood test for the EGFR (epidermal growth factor receptor) gene, used mainly in oncology, for example to guide targeted therapy in non-small-cell lung cancer.

Because it is a genetic and targeted-therapy test, cover and pre-authorization rules vary by insurer, so confirm benefits with Bupa, AXA Health, Aviva, Allianz Care, or Cigna before testing.

Pabau’s claims management software helps UK private practices link the laboratory result and clinical indication to CCSD-coded invoices, reducing rejections.

CCSD Code 0005G is the Single Gene Test EGFR (blood), a diagnostic pathology test listed in the Diagnostic Tests Schedule maintained by the Clinical Coding and Schedule Development (CCSD) Group, the industry-standard framework UK private insurers use to identify and reimburse clinical activity. It sits in Chapter 34 (Pathology) of the schedule, among the molecular and genetic tests, and replaces the older code 4198B. The authoritative narrative is held in the login-gated schedule at ccsd.org.uk, which requires a registered account.

The test detects mutations in the EGFR (epidermal growth factor receptor) gene from a blood sample. In private practice it is ordered mainly in oncology, for example to identify EGFR-activating mutations in non-small-cell lung cancer that predict response to EGFR tyrosine kinase inhibitors, or to detect resistance mutations during treatment. Because it is a single gene test performed on blood rather than a procedure carried out on the body, billing it correctly is a question of matching the right diagnostic code and confirming insurer cover, not of laterality or surgical technique.

Clinics leaving the NHS for private practice often encounter the CCSD Schedule for the first time when they onboard their first insurer relationship. Getting familiar with how pathology codes such as 0005G are recognized early prevents common submission errors.

When to use this code

Code 0005G should be used when an EGFR single gene test has been performed on a blood sample and reported by the laboratory. Because the CCSD Schedule is access-controlled (full narratives require a registered login at ccsd.org.uk), always verify the exact wording for 0005G against your current schedule access before billing. The following principles apply:

• The test reported must match the code narrative. Do not use 0005G to bill a different molecular or pathology test covered by another code, and do not bill it for a multi-gene panel when only the single gene EGFR test was performed.
• 0005G replaces the older code 4198B. Make sure your code tables and templates use the current code, as submitting a superseded code is a common rejection trigger.
• The specimen is blood. Confirm the sample type recorded on the laboratory request matches before billing.
• Because this is a genetic and targeted-therapy test, many insurers require pre-authorization. Confirm the test is a covered benefit and authorized before the sample is taken.

Practices operating across multiple sites should confirm that each requesting clinician knows when 0005G applies versus when a different molecular pathology code is more appropriate.

How the code is classified in the CCSD Schedule

The CCSD Schedule is divided into a Procedure Codes Schedule and a Diagnostic Tests Schedule, each subdivided into numbered chapters. Code 0005G belongs to a single chapter of the Diagnostic Tests Schedule — it is not dual-classified across both schedules and it is not a procedure code.

As the CCSD Group clarifies in its published FAQs, diagnostic codes represent diagnostic service charges and are handled differently from procedure codes, including how they are loaded into insurer code tables. Submitting a diagnostic pathology code such as 0005G through a procedure code pathway is a common rejection trigger, so make sure your billing system records it as a diagnostic test.

Documentation requirements

UK private medical insurers require clear, contemporaneous records before they will process a claim for an EGFR single gene test. Incomplete documentation is one of the most consistent reasons claims are queried or rejected, and genetic tests attract closer medical-necessity scrutiny than routine investigations. Your records supporting a 0005G claim should include:

• Clinical indication: The diagnosis or clinical question that justified EGFR testing, for example a confirmed or suspected non-small-cell lung cancer where a targeted-therapy decision depends on the result, recorded before the sample was taken.
• Laboratory report: The molecular pathology report confirming the EGFR single gene test was performed and stating the result; without it the insurer cannot verify the test.
• Requesting clinician and date: The name and registration number of the requesting clinician and the specimen collection date, which establishes the date of service and confirms active cover.
• Consent record: Documented patient consent for genetic testing, ideally timestamped and stored alongside the clinical note.
• Pre-authorization reference: Where the insurer required prior approval, the authorization reference attached to the claim.

Using digital forms for clinical documentation ensures your records are structured, timestamped, and attached directly to the patient record at the point of care. This matters when an insurer requests supporting notes for a 0005G claim weeks after the sample was taken, so the evidence trail is already in place when you submit.

Practices should also be aware of UK GDPR obligations when retaining patient records, which carry particular weight for genetic-test data. A UK GDPR compliance checklist can help confirm your record retention and data handling practices meet ICO requirements alongside insurer expectations.

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Which insurers accept it

The major UK private medical insurers use the CCSD Schedule as the basis for their diagnostic and procedure code tables. Bupa confirms on its Bupa Code Search portal that it uses CCSD-developed codes for clinical activity coding in independent healthcare, and the other major insurers follow the same framework. Accepting the CCSD coding format is not the same as guaranteeing reimbursement, however, and molecular or genetic testing is more likely than routine pathology to need pre-authorization or to be subject to specific cover rules. The table below summarizes insurer acceptance and submission notes:

For a broader overview of how these insurers approach CCSD-coded invoicing, the Bupa CCSD codes guide covers Bupa’s submission process in detail and is a useful reference for understanding how the largest UK private insurer applies the schedule.

How to submit a claim

Most UK private medical insurers accept electronic submissions through Healthcode, the UK’s electronic billing network for private healthcare. Paper invoicing is still accepted by some insurers but is slower and carries a higher risk of data entry errors. A standard 0005G claim should include:

1. Patient and policy details: Full name, date of birth, insurer membership number, and policy number as provided by the patient at registration.
2. Requesting clinician details: The clinician’s name, GMC or relevant registration number, and their recognized provider number with the specific insurer.
3. Diagnostic code entry: Enter code 0005G (Single Gene Test EGFR, blood) with the correct narrative, specimen collection date, and fee, recorded as a Chapter 34 (Pathology) diagnostic test rather than a procedure.
4. Supporting authorization reference: If the insurer issued a pre-authorization number for the test, include it on the invoice. Claims submitted without a valid authorization reference where one is required are a frequent rejection cause.
5. Invoice total and payment terms: Include your practice’s bank details or payment instructions in line with the insurer’s invoicing requirements.

Related Chapter 34 pathology codes

Code 0005G sits among other pathology codes in Chapter 34 of the CCSD Schedule. These are separate diagnostic codes, each with its own narrative and fee — not a clinical “series” of interchangeable procedures — so they are not easily confused at the bench, but billing teams should still select the one that matches the test the laboratory actually performed:

• 0001G: A separate single gene test code in Chapter 34 (Pathology), with its own narrative and fee. The CCSD code 0001G reference covers its specific billing rules.
• 0004G: The B Cell Memory Panel, an immunology panel — a completely different test from an EGFR single gene assay, despite the similar code number. Match the code to the laboratory report rather than assuming adjacent numbers describe related tests.
• 0005G: The Single Gene Test EGFR (blood) covered in this article. Always use the narrative from your registered CCSD schedule access as the definitive basis for code selection, not third-party summaries.

Clinics supporting the operational demands of running a private practice will benefit from building a simple internal coding reference that maps the molecular and pathology tests they order to the correct CCSD code. This reduces reliance on individual clinician recall and creates a consistent billing baseline across the team.

Common billing errors

Errors with code 0005G tend to cluster around a small number of recurring issues. Addressing these before submission reduces rejections and avoids the administrative overhead of resubmission cycles.

• Using a superseded or wrong code: Submitting the old code 4198B instead of 0005G, or billing a different molecular pathology code, is the most common error. Always verify the narrative match from your registered schedule access.
• Billing the wrong test: Charging a multi-gene panel code when only the single gene EGFR test was performed, or confusing 0005G with an unrelated Chapter 34 code such as 0004G (B Cell Memory Panel). Match the code to the laboratory report.
• Missing pre-authorization: Molecular and genetic tests often require prior approval. Submitting 0005G without an authorization reference where the insurer requires one triggers an automatic query.
• Weak clinical indication: Insurers may request supporting records for a genetic test at any point after payment. Notes that do not document why EGFR testing was clinically necessary create audit risk.
• Outdated fee figures: Insurer fee schedules are updated periodically. Using an old fee figure for 0005G can result in underpayment or a query that delays the full payment.

Conclusion

CCSD Code 0005G is the Single Gene Test EGFR (blood), a Chapter 34 (Pathology) diagnostic test rather than a surgical procedure, and it replaces the older code 4198B. Billing it accurately means selecting the current code, matching it to the laboratory report, confirming the test is a covered benefit, securing pre-authorization where the insurer requires it, and backing the claim with a clear clinical indication. The most common errors — using a superseded code and submitting without confirming cover — are preventable with the right pre-submission workflow.

Submitting EGFR single gene test (0005G) and other pathology claims to Bupa, AXA Health, and Aviva? Pabau’s claims management software links the laboratory result and clinical indication straight to the CCSD-coded invoice, so genetic-test claims clear first time. Book a demo to see it.

Continue your research

Need practitioner-facing fee references? Bupa procedure codes fee schedule explains how Bupa structures its CCSD-based fees and where to find current reimbursement figures.

Building your clinical compliance documentation? Compliance documentation requirements is a useful reference framework for record-keeping that supports clean insurer claims.

Handling referrals between private and NHS care? Private GP referral pathways explains how referral routes interact with insurer authorization for tests and treatment.

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