Summary & Overview
CPT 81453: Targeted Genomic Sequence Analysis Panel for Solid Organ Neoplasms
CPT code 81453 represents targeted genomic sequence analysis panels for solid organ neoplasms, analyzing DNA from 5 to 50 genes. This advanced laboratory procedure is increasingly important in oncology, as it supports precision medicine by identifying genetic mutations relevant to cancer diagnosis and treatment. The code is primarily utilized in independent laboratory settings, reflecting the growing role of molecular diagnostics in cancer care.
Blue Cross Blue Shield is a key payer covering this service, highlighting its national relevance and widespread adoption. Readers will gain insights into clinical benchmarks, policy updates, and the broader context of genomic testing in oncology. The publication also explores related codes, common modifiers, and associated taxonomies, providing a comprehensive overview of billing and clinical considerations for 81453. Understanding this code is essential for stakeholders navigating the evolving landscape of molecular pathology and laboratory medicine.
CPT Code Overview
CPT code 81453 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 information for the diagnosis and management of various cancers. The service falls under Pathology and Laboratory and is typically performed in an Independent Laboratory setting (Place of Service 81). This code enables clinicians to obtain detailed genetic profiles of tumors, supporting personalized treatment strategies and improving patient outcomes.
Clinical & Coding Specifications
Clinical Context
A patient diagnosed with a solid organ neoplasm, such as lung, breast, colon, prostate, or pancreatic cancer, is referred for advanced molecular testing. The treating oncologist requests targeted genomic sequence analysis 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 molecular pathology. The laboratory performs DNA analysis using a targeted panel to guide potential treatment options, such as targeted therapies or clinical trial eligibility. Results are interpreted by a pathologist with expertise in molecular genetic pathology and reported back to the clinical team for integration into the patient's care plan.
Coding Specifications
-
Modifier
26: Used to indicate the professional component, when only the interpretation of the test is performed by the provider. -
Modifier
59: Used to denote a distinct procedural service, when the procedure is separate from other services performed on the same day.
| Modifier Code | Description |
|---|---|
26 | Professional Component |
59 | Distinct Procedural Service |
- Associated Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207ZP0102X | Pathology - Clinical Pathology/Laboratory Medicine |
207ZP0007X | Pathology - Molecular Genetic Pathology |
207L00000X | Anatomic Pathology |
These taxonomies represent providers specializing in laboratory medicine, molecular genetic pathology, and anatomic pathology, all of whom may be involved in ordering, performing, or interpreting targeted genomic sequence analysis panels.
Related Diagnoses
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C34.90: Malignant neoplasm of unspecified part of unspecified bronchus or lung- Relevant for patients with lung cancer undergoing genomic analysis to identify actionable mutations.
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C50.919: Malignant neoplasm of unspecified site of unspecified female breast- Used for breast cancer cases where targeted genomic sequencing may inform therapy selection.
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C18.9: Malignant neoplasm of colon, unspecified- Applies to colon cancer patients, supporting molecular profiling for personalized treatment.
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C61: Malignant neoplasm of prostate- For prostate cancer, genomic analysis can reveal mutations impacting prognosis and therapy.
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C25.9: Malignant neoplasm of pancreas, unspecified- Pancreatic cancer cases benefit from targeted sequencing to identify potential therapeutic targets.
Each diagnosis code represents a solid organ neoplasm for which targeted genomic sequence analysis (81453) is clinically relevant to guide management and treatment decisions.
Related CPT Codes
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88342: Immunohistochemistry, per specimen- Used to detect specific proteins in tissue samples, often performed alongside genomic testing to further characterize the tumor.
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88341: Immunohistochemistry, each additional single antibody stain- Applied when multiple antibody stains are needed for a specimen, complementing molecular analysis.
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81445: Targeted genomic sequence analysis panel, hematolymphoid neoplasm, DNA analysis, 5-50 genes- Similar to
81453, but used for hematolymphoid neoplasms rather than solid organ tumors. Not used together, but as an alternative based on tumor type.
- Similar to
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81235: EGFR gene analysis, common variants- Focuses on EGFR mutations, which may be included in the broader panel of
81453or ordered separately for specific clinical questions.
- Focuses on EGFR mutations, which may be included in the broader panel of
Codes 88342 and 88341 are commonly used together with 81453 in the workflow for comprehensive tumor profiling. Code 81445 is an alternative for hematolymphoid neoplasms, while 81235 may be used as a standalone or adjunct test.