CPT 0794T: Algorithmic Oncology Therapy Ranking - OpenPayer

Summary & Overview

CPT 0794T: Algorithmic Oncology Therapy Ranking

CPT code 0794T represents an algorithmic clinical decision-support service that ingests a patient’s clinical and existing molecular, laboratory, or pathology data to produce a ranked report of cancer drug therapies based on tumor biomarkers. The code codifies use of software-driven interpretation to guide targeted oncology treatment selection, reflecting growing integration of molecular diagnostics and informatics into clinical oncology care nationwide.

Key payers covered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical purpose, typical service settings, and national relevance. The publication summarizes benchmarking considerations for coverage and payment, outlines policy updates and payer approaches to algorithmic or software-based decision support, and situates the code within clinical workflows for precision oncology.

The report also provides practical context on service lines where this code is billed, implications for laboratory and oncology practice operations, and areas where payers and providers commonly focus reviews or prior authorization. Data not available in the input is explicitly noted where relevant.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare0794TCPToncologyclinical decision supportmolecular diagnosticsprecision medicinealgorithmic reporttherapeutic selection

Billing Code Overview

CPT code 0794T describes a clinical decision-support service in which a provider submits a patient’s clinical and existing molecular, laboratory, or pathology result data for algorithmic assessment. An algorithmic program generates a report that ranks available cancer drug therapies based on the patient’s cancer biomarkers.

Service type: Algorithmic clinical decision support for oncology therapeutic selection
Typical site of service: Oncology clinic, hospital outpatient department, or other ambulatory care settings where diagnostic and molecular data are available

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient with metastatic non–small cell lung cancer previously underwent tumor biopsy and comprehensive molecular profiling. The treating oncologist collects the patient’s clinical history, pathology reports, and prior laboratory and molecular test results and submits these data to an FDA-cleared algorithmic decision-support platform. The platform aggregates biomarker status (e.g., EGFR, ALK, ROS1, PD-L1, NTRK), prior therapies, comorbidities, and lab values and generates a ranked report of potential systemic cancer therapies and targeted agents for consideration. The service is typically ordered in the outpatient oncology clinic or via an oncology specialty practice prior to a treatment-planning conference; the typical site of service is outpatient clinic or physician office. The report is used to inform multidisciplinary tumor board discussion and to guide selection of targeted therapy, immunotherapy, or inclusion in biomarker-directed clinical trials. Clinicians incorporate the algorithmic ranking alongside clinical judgment, pathologist input, and patient preferences when finalizing therapy plans.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when documentation supports substantially greater complexity in preparing and submitting extensive clinical or molecular data beyond typical scope.

23

Taxonomy Code	Specialty	Notes
208000000X	Medical Oncology	Primary ordering and interpreting specialty for biomarker-driven therapy selection.
207RC0000X	Hematology/Oncology	Physicians with combined hematology/oncology practice often coordinate molecular-informed treatment planning.
207P00000X	Pathology	Anatomic and molecular pathologists supply tumor biomarker data and confirm test appropriateness.
363L00000X	Laboratory Director	Laboratory medicine specialists oversee quality and interpretation of molecular and genomic test data.
186000000X	Geneticist/Genetic Counselor	Provide germline interpretation and counseling relevant to hereditary biomarkers and therapy implications.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C34.90`	Malignant neoplasm of unspecified part of unspecified bronchus or lung	Common primary diagnosis for algorithmic targeted therapy selection in non–small cell lung cancer cases.
`C50.919`	Malignant neoplasm of unspecified site of unspecified female breast	Breast cancer cases frequently use molecular profiling to guide targeted therapy recommendations.
`C61`	Malignant neoplasm of prostate	Advanced prostate cancer with actionable genomic alterations may be assessed by algorithmic therapy ranking.
`C18.9`	Malignant neoplasm of colon, unspecified	Colorectal cancers with RAS, BRAF or MSI status inform therapy rankings.
`C25.9`	Malignant neoplasm of pancreas, unspecified	Pancreatic tumors with specific biomarkers (e.g., BRCA) may influence targeted therapy options.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`81350`	BRCA1 and BRCA2 full gene sequence analysis	Often performed before or alongside algorithmic therapy ranking when hereditary or somatic BRCA status may affect targeted therapy selection.
`81445`	Oncology (solid tumor) multigene panel, DNA sequence analysis, 5-50 genes	Provides the tumor genomics data that feed into the algorithmic assessment and influence ranked therapy options.
`88271`	Flow cytometry, cell surface and cytoplasmic antigen detection, multiplexed	May be used for hematologic malignancies where immunophenotyping informs therapy choices incorporated into the algorithmic report.
`88367`	Surgical pathology, consultation and report, consultation on pathology material	Pathology consultative services that verify histology and biomarker testing prior to algorithmic assessment.
`99457`	Remote physiologic monitoring treatment management services	Occasionally used when ongoing remote monitoring or telehealth follow-up is billed after implementation of algorithm-guided therapy decisions.