Summary & Overview
CPT 81423: Genomic Sequence Analysis Panel for Solid Organ Neoplasms
CPT code 81423 represents a genomic sequence analysis panel for solid organ neoplasms, focusing on DNA analysis of 5-50 genes. This code is significant in the national landscape of oncology diagnostics, as it enables detailed molecular profiling of tumors, which is critical for guiding targeted therapies and improving patient outcomes. The procedure is classified under Pathology and Laboratory services and is most commonly performed in laboratory settings.
Blue Cross Blue Shield is a key payer covering this code, reflecting its importance in commercial insurance coverage for advanced cancer diagnostics. Readers will gain insights into clinical benchmarks, policy updates, and the broader context of genomic testing in cancer care. The publication also addresses relevant modifiers, associated taxonomies, ICD-10 diagnoses, and related CPT codes, providing a comprehensive overview for stakeholders involved in medical billing, coding, and policy analysis. Understanding the scope and application of CPT code 81423 is essential for navigating reimbursement and compliance in the evolving field of molecular pathology.
CPT Code Overview
CPT code 81423 is used for genomic sequence analysis panels targeting solid organ neoplasms. This procedure involves DNA analysis of 5-50 genes to identify genetic mutations relevant to cancer diagnosis and treatment. The service falls under Pathology and Laboratory and is typically performed in a laboratory setting (Place of Service 81). This code is essential for comprehensive molecular profiling of tumors, supporting precision medicine approaches in oncology.
Clinical & Coding Specifications
Clinical Context
A patient with a newly diagnosed solid organ neoplasm, such as lung, breast, colon, prostate, or pancreatic cancer, is referred for advanced molecular testing. The treating oncologist or pathologist orders genomic sequence analysis to evaluate the tumor's DNA for mutations across a panel of 5-50 genes. The specimen is sent to a laboratory (Place of Service 81), where the test is performed to guide targeted therapy, prognosis, or further diagnostic workup. Results are interpreted by a pathology or oncology physician and integrated into the patient's care plan.
Coding Specifications
-
Modifiers:
- Modifier
26: Used when reporting only the professional component (interpretation of results) of the procedure. - Modifier
TC: Used when reporting only the technical component (performance of the test in the laboratory).
- Modifier
-
Provider Taxonomies:
Code Specialty 207ZP0102X