Summary & Overview
CPT 81445: Targeted Genomic Sequence Analysis Panel for Solid Organ Neoplasms
CPT code 81445 represents targeted genomic sequence analysis panels for solid organ neoplasms, analyzing DNA across 5 to 50 genes. This laboratory-based molecular pathology service is increasingly important in oncology, supporting precision medicine by identifying genetic mutations that inform diagnosis and treatment strategies for cancer patients. Nationally, the code is recognized by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, reflecting broad coverage and relevance across the healthcare landscape.
This publication provides a comprehensive overview of 81445, including payer coverage, clinical context, and related coding benchmarks. Readers will gain insight into the laboratory service's role in cancer care, typical sites of service, and how it fits within the broader framework of genomic testing. The analysis also highlights associated modifiers, taxonomies, and ICD-10 diagnoses relevant to solid organ neoplasms, as well as related CPT codes that may be used in similar clinical scenarios. Policy updates and coding trends are discussed to inform stakeholders about the evolving landscape of molecular pathology billing and reimbursement.
CPT Code Overview
CPT code 81445 is used for targeted genomic sequence analysis panels focused on solid organ neoplasms. This procedure involves DNA analysis of 5 to 50 genes, providing critical molecular information to guide diagnosis and treatment decisions for patients with solid organ tumors. The service is classified under Laboratory – Genomic Sequencing / Molecular Pathology and is typically performed in a laboratory setting, designated as Place of Service 81. This code is central to advancing precision medicine in oncology, enabling clinicians to identify genetic mutations relevant to cancer care.
Clinical & Coding Specifications
Clinical Context
A patient with a suspected or confirmed solid organ neoplasm, such as lung cancer or mesothelioma, is referred for targeted genomic sequence analysis. The ordering physician, often an oncologist or pulmonologist, requests a laboratory to analyze a tumor sample for DNA variants across a panel of 5–50 genes. The results help guide treatment decisions, such as targeted therapies or eligibility for clinical trials. The laboratory performs the sequencing, and a pathologist or molecular geneticist interprets the findings. The service is typically rendered in a laboratory setting (Place of Service 81), and the report is sent back to the ordering provider for clinical integration.
Coding Specifications
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Modifiers:
- Modifier
26: Used when billing for the professional component (interpretation and report) of the laboratory service. - Modifier
TC: Used when billing for the technical component (performance of the test) of the laboratory service. - Modifier
59: Used to indicate a distinct procedural service, typically when multiple procedures are performed that are not normally reported together.
- Modifier
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207ZP0102X | Pathology - Clinical Pathology/Laboratory Medicine |
207ZP0007X | Pathology - Molecular Genetic Pathology |
207Q00000X | Family Medicine Physician |
These taxonomies represent providers who may order, perform, or interpret genomic sequencing panels for solid organ neoplasms.
Related Diagnoses
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C33: Malignant neoplasm of trachea- Relevant for patients with tracheal cancer undergoing genomic analysis to guide treatment.
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C34.92: Malignant neoplasm of unspecified part of left bronchus or lung- Applies to patients with lung cancer where the specific site is not identified, supporting genomic testing for targeted therapy.
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C38.4: Malignant neoplasm of pleura- Used for patients with pleural cancer, often requiring molecular profiling for management decisions.
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C45.0: Mesothelioma of pleura- Pertinent for patients diagnosed with pleural mesothelioma, where genomic sequencing may inform prognosis and therapy options.
Related CPT Codes
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81449: Solid organ neoplasm, genomic sequence analysis panel, 5–50 genes, interrogation for sequence variants and copy number variants or rearrangements, if performed.- This code is used for a more comprehensive analysis, including copy number variants or rearrangements, and may be used as an alternative or in conjunction with
81445depending on the clinical need.
- This code is used for a more comprehensive analysis, including copy number variants or rearrangements, and may be used as an alternative or in conjunction with
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0048U: Proprietary genomic test code (paired in same coverage context as81445).- This code represents a specific proprietary test and is often used in the same clinical scenarios as
81445, either as an alternative or when a particular test is required by the ordering provider or payor.
- This code represents a specific proprietary test and is often used in the same clinical scenarios as
These codes are commonly used together or as alternatives based on the scope of genomic analysis required for solid organ neoplasms.