Summary & Overview
CPT 81175: ASXL1 Gene Full-Sequence Analysis
CPT code 81175 identifies a technical laboratory service that performs full-sequence analysis of the ASXL1 gene, a transcriptional regulator with clinical relevance in hematologic and oncologic disorders. As a molecular diagnostic sequencing procedure, this code matters nationally because genetic results can guide diagnosis, prognosis, and targeted therapy selection across multiple care settings, and demand for such genomic testing is growing across clinical and laboratory networks.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for ASXL1 sequencing, typical laboratory service delivery and sites of service, coverage considerations by major payers, and standard billing elements such as common modifiers and the service line. The publication outlines typical coding practice for the technical component of full-gene sequencing and highlights where data is available versus not provided.
This summary equips payers, laboratory managers, and billing professionals with a national-level understanding of what CPT code 81175 represents, why ASXL1 sequencing is clinically significant, and which payers commonly cover similar molecular diagnostic services. Data not available in the input is explicitly noted where applicable.
Billing Code Overview
CPT code 81175 describes a laboratory technical procedure that analyzes the entire gene sequence for the additional sex combs like 1 (ASXL1) transcriptional regulator gene. The service type is molecular genetic sequencing / targeted gene sequencing, focusing on comprehensive sequence analysis for the specified gene. The typical site of service is a clinical molecular diagnostics laboratory or reference laboratory performing high-complexity sequencing assays.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with unexplained cytopenias and suspicion for myelodysplastic syndrome (MDS) is referred to a hematologist-oncologist. Peripheral blood and bone marrow aspirate are evaluated; cytogenetic studies and targeted next-generation sequencing (NGS) panels are ordered to identify somatic mutations that impact prognosis and therapy. The laboratory performs a full gene sequencing assay to analyze the entire coding region of the ASXL1 (additional sex combs like 1) transcriptional regulator gene to detect frameshift, nonsense, and missense variants. Sequencing is performed in a CLIA-certified molecular diagnostics laboratory by a molecular technologist and bioinformatician; raw data processing, variant calling, and interpretation follow validated pipelines. Results are reported to the ordering clinician and incorporated into the diagnostic assessment, risk stratification, and treatment planning (for example, guiding eligibility for targeted therapies or clinical trials). Typical specimen sources include peripheral blood or bone marrow aspirate. Typical sites of service are hospital outpatient laboratories, independent diagnostic laboratories, and academic medical center molecular laboratories.
Coding Specifications
- Modifier table
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When only the physician interpretation or report is billed separately from the lab technical component |