Summary & Overview
CPT 81170: ABL1 Kinase Domain Variant Analysis, Technical Component
CPT code 81170 identifies the laboratory technical procedure for analyzing variants in the kinase domain of the ABL1 gene (BCR/ABL), a molecular test with direct clinical implications for diagnosis, prognostication, and targeted therapy in hematologic malignancies. Nationally, molecular oncology testing like this is central to precision medicine workflows and authorization, coding, and payment discussions among providers and payers.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code's clinical context and typical service setting, plus what to expect in reimbursement and coverage reviews: benchmarking of payment and utilization (where available), common billing and claim considerations, and policy updates affecting molecular diagnostic services. The publication also outlines clinical relevance for oncology care teams and laboratory directors, and highlights coding relationships and documentation elements needed to support claims.
This summary is intended for a national audience of payers, provider billing teams, laboratory managers, and policy analysts seeking a focused briefing on CPT code 81170 and its role in molecular diagnostic testing for ABL1 kinase domain variants.
Billing Code Overview
CPT code 81170 describes a laboratory technical procedure that analyzes variants in the kinase domain of the ABL1 gene (also referred to as BCR/ABL or ABL proto-oncogene 1 nonreceptor tyrosine kinase). The service involves laboratory analytic work to detect and characterize gene variants relevant to diagnosis, prognosis, and targeted therapy selection for hematologic malignancies.
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Service type: Molecular diagnostic laboratory test (technical component)
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Typical site of service: Clinical laboratory or hospital laboratory performing molecular diagnostics
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Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with chronic myeloid leukemia (CML) presents for molecular testing to assess for ABL1 kinase domain mutations after loss of hematologic response to tyrosine kinase inhibitor therapy. Peripheral blood or bone marrow is collected and sent to a molecular diagnostics laboratory. The laboratory analyst performs the technical assay using sequencing or targeted mutation analysis to detect variants in the ABL1 kinase domain (81170). Results are used by the treating hematologist/oncologist to guide selection of second-line tyrosine kinase inhibitors and to determine resistance-associated mutations. Typical workflow steps include specimen accessioning, DNA/RNA extraction, PCR amplification or library preparation, sequencing/variant detection, bioinformatic analysis, quality control, and reporting. Usual sites of service are hospital-based molecular laboratories, independent diagnostic laboratories, and academic medical center molecular pathology labs. Patient encounter settings initiating the test include outpatient hematology/oncology clinics, inpatient hematology services, and infusion centers where therapy response is monitored.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing for the interpretive component performed by a pathologist or laboratory director separate from the technical component |