Summary & Overview
CPT 81463: Targeted Genomic Sequence Analysis Panel for Solid Organ Neoplasms
CPT code 81463 is a targeted genomic sequence analysis panel used in the evaluation of solid organ neoplasms, analyzing DNA from 5 to 50 genes. This code is significant in the national landscape of molecular pathology, as it supports the growing demand for precision oncology and personalized cancer treatment. The procedure is typically performed in independent laboratories and is covered by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.
This publication provides a comprehensive overview of CPT 81463, including payer coverage, clinical context, and related billing codes. Readers will gain insights into current policy updates, reimbursement benchmarks, and the role of genomic testing in cancer care. The summary also highlights associated modifiers and taxonomies relevant to laboratory medicine and molecular genetic pathology. By understanding the scope and application of this code, stakeholders can better navigate the evolving landscape of molecular diagnostics and laboratory billing.
CPT Code Overview
CPT 81463 represents a targeted genomic sequence analysis panel for solid organ neoplasms, focusing on DNA analysis of 5 to 50 genes. This procedure is classified under Pathology and Laboratory services and is typically performed in an Independent Laboratory setting (POS 81). The test is designed to provide detailed genetic information relevant to the diagnosis and management of solid organ tumors, supporting precision medicine approaches in oncology.
Clinical & Coding Specifications
Clinical Context
A patient diagnosed with a malignant neoplasm of the gastrointestinal tract, such as the small intestine, colon, rectum, or anal canal, is referred for advanced molecular testing. The treating oncologist requests a targeted genomic sequence analysis panel to identify mutations in 5-50 genes relevant to solid organ neoplasms. The specimen, typically a tissue biopsy from the tumor, is sent to an independent laboratory (Place of Service 81). A pathologist specializing in molecular genetic pathology oversees the DNA analysis, which assists in guiding targeted therapy and prognosis. The workflow involves specimen collection, laboratory processing, genomic sequencing, and interpretation of results by a qualified pathologist.
Coding Specifications
-
Modifiers:
- Modifier
26: Used when reporting only the professional component of the laboratory service, such as interpretation of results by a pathologist. - Modifier
59: Indicates a distinct procedural service, used when the genomic panel is performed separately from other procedures.
- Modifier
-
Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|