Summary & Overview
CPT 81413: Genomic Sequence Analysis Panel for Solid Organ Neoplasms
CPT code 81413 represents a genomic sequence analysis panel for solid organ neoplasms, focusing on DNA analysis of 5 to 50 genes. This code is significant in the national landscape of cancer diagnostics, as it enables clinicians to obtain detailed genetic profiles of tumors, which can guide personalized treatment strategies. The procedure is classified under Pathology and Laboratory services and is most commonly performed in independent laboratory settings.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, provide coverage for this code, reflecting its widespread clinical adoption and relevance. Readers will gain insights into payer coverage, clinical indications, and related billing codes, as well as policy updates and benchmarks relevant to genomic testing for solid organ neoplasms. The publication also explores associated ICD-10 diagnoses, such as malignant neoplasms of the lung, breast, colon, prostate, and pancreas, and highlights related CPT codes for immunohistochemistry and morphometric analysis.
This summary offers a comprehensive overview of the clinical context, payer landscape, and coding considerations for CPT code 81413, equipping stakeholders with the information needed to understand its role in cancer diagnostics and laboratory medicine.
CPT Code Overview
CPT code 81413 is used to report a genomic sequence analysis panel for solid organ neoplasms, specifically DNA analysis involving 5 to 50 genes. This procedure falls under the Pathology and Laboratory service type and is typically performed in an Independent Laboratory setting (Place of Service 81). The test is designed to provide comprehensive genetic information that can inform diagnosis and treatment decisions for patients with solid organ tumors.
Clinical & Coding Specifications
Clinical Context
A patient with a newly diagnosed solid organ malignancy, such as lung, breast, colon, prostate, or pancreatic cancer, is referred for advanced molecular testing. The treating oncologist requests a genomic sequence analysis panel to identify mutations in 5-50 genes relevant to the tumor type. The specimen, typically a tissue biopsy, is sent to an independent laboratory (Place of Service 81) specializing in pathology and molecular diagnostics. The laboratory performs DNA analysis using CPT code 81413 to guide targeted therapy and inform prognosis. Results are interpreted by a pathologist or molecular oncologist and reported back to the treating physician for clinical decision-making.
Coding Specifications
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Modifiers:
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Modifier
26: Used to indicate the professional component, which covers the interpretation and reporting of the genomic sequence analysis by a qualified physician or pathologist. -
Modifier
TC: Used to indicate the technical component, which covers the performance of the laboratory test, including specimen processing and DNA sequencing.
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Provider Taxonomies:
Taxonomy Code