Summary & Overview
CPT 81454: Targeted Genomic Sequence Analysis Panel for Solid Organ Neoplasms
CPT code 81454 represents a targeted genomic sequence analysis panel for solid organ neoplasms, analyzing DNA from 5 to 50 genes. This advanced laboratory procedure is pivotal in oncology, offering precise genetic insights that inform diagnosis, prognosis, and personalized treatment plans for patients with cancers such as lung, breast, colon, prostate, and pancreas. The code is primarily utilized in independent laboratory settings, reflecting the growing role of molecular pathology in cancer care.
Blue Cross Blue Shield is a key payer covering this service, highlighting its national relevance and widespread adoption. Readers will gain an understanding of the clinical context for 81454, including its application in cancer diagnostics, typical laboratory workflow, and associated billing practices. The publication also provides benchmarks and policy updates relevant to pathology and laboratory services, helping stakeholders stay informed about evolving trends in genomic testing.
This summary offers a comprehensive overview of 81454, its significance in modern oncology, and the payer landscape, equipping healthcare professionals, administrators, and policy analysts with essential information for decision-making and operational planning.
CPT Code Overview
CPT code 81454 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 is classified 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 targeted genomic sequence analysis. The ordering physician requests DNA analysis of 5-50 genes to identify mutations relevant for prognosis or targeted therapy. The specimen is sent to an independent laboratory (Place of Service 81), where a pathologist specializing in molecular genetic pathology oversees the testing. The results inform treatment decisions, such as eligibility for targeted therapies or clinical trials.
Coding Specifications
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Modifiers:
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26: Used when billing for the professional component, which includes interpretation and reporting by the pathologist. - Modifier
TC: Used when billing for the technical component, which covers the laboratory processing and analysis of the specimen.
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Provider Taxonomies:
Taxonomy Code Specialty Name 207ZP0102X