Summary & Overview
CPT 81457: Genomic Sequence Analysis Panel for Solid Organ Neoplasms
CPT code 81457 is a pivotal billing code for genomic sequence analysis panels targeting solid organ neoplasms. This code is used by diagnostic laboratories to interrogate sequence variants in tumor samples, providing essential molecular insights for cancer diagnosis and treatment planning. The procedure is part of the broader molecular pathology and genomic sequencing service line, reflecting the growing importance of precision medicine in oncology.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, recognize and reimburse for this code, underscoring its clinical and financial relevance across the United States. The publication offers a comprehensive overview of payer coverage, clinical indications, and related coding practices, equipping readers with up-to-date benchmarks and policy updates. It also contextualizes 81457 within the landscape of genomic testing, highlighting its role alongside related CPT codes for both DNA- and RNA-based panels.
Readers will gain insights into the clinical context for use, typical laboratory settings, and the spectrum of associated diagnoses, such as various malignant neoplasms of the gastrointestinal tract. The summary also addresses common modifiers and taxonomies relevant to billing and compliance. This resource is designed for healthcare professionals, laboratory administrators, and policy analysts seeking a clear understanding of 81457 and its place in modern cancer care.
CPT Code Overview
CPT code 81457 represents a solid organ neoplasm genomic sequence analysis panel, specifically designed for the interrogation of sequence variants. This procedure falls under the molecular pathology and genomic sequencing procedures service type. It is typically performed in a diagnostic laboratory setting, such as a CLIA-certified lab, where advanced genomic technologies are used to analyze tumor samples from solid organs. The test provides critical information for the diagnosis and management of cancer by identifying genetic mutations that may influence treatment decisions.
Clinical & Coding Specifications
Clinical Context
A patient with a newly diagnosed malignant neoplasm of the gastrointestinal tract, such as the rectum, small intestine, or appendix, is referred for advanced molecular testing. The treating oncologist requests a comprehensive genomic sequence analysis panel to identify sequence variants in the tumor tissue. The specimen is sent to a CLIA-certified diagnostic laboratory, where a pathologist oversees the genomic sequencing procedure. The results help guide targeted therapy decisions and inform prognosis. The workflow involves specimen collection, laboratory processing, genomic sequencing, and interpretation by a pathology or oncology specialist.
Coding Specifications
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Modifier
26: Used when reporting only the professional component of the service, such as interpretation of the genomic sequencing results by a physician. -
Modifier
TC: Used when reporting only the technical component, which includes laboratory processing and sequencing.
| Modifier Code | Description |
|---|---|
26 | Professional Component |