Summary & Overview
CPT 81191: NTRK1 Translocation Testing on FFPE Tumor Tissue
CPT code 81191 designates a laboratory technical assay that evaluates FFPE tumor tissue for NTRK1 translocations linked to TRK‑mediated oncogenic signaling. These molecular tests are clinically important because identifying NTRK fusions can affect targeted therapy selection for patients with certain solid tumors and influence care pathways on a national level. Major payers covered 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 NTRK1 fusion testing, payer coverage considerations, and typical billing practices tied to the technical laboratory component. The publication presents national benchmarks where available, notes relevant policy and coding updates, and summarizes the expected service setting and workflow implications for laboratories. It also outlines common modifiers and procedural relationships to help payers and providers align coding and claims handling. Data not available in the input is identified where applicable.
Billing Code Overview
CPT code 81191 describes a laboratory technical service that analyzes formalin–fixed, paraffin-embedded (FFPE) tissue to detect NTRK1 (neurotrophic receptor tyrosine kinase 1) translocations associated with TRK‑mediated cell proliferation in certain solid tumors. This service involves laboratory processing and analytic testing performed by a lab analyst on a patient specimen.
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Service type: Molecular pathology / laboratory technical component for targeted fusion/translocation testing
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Typical site of service: Clinical laboratory or hospital pathology laboratory handling FFPE tissue specimens
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Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a newly diagnosed metastatic non–small cell lung cancer (NSCLC) undergoes tumor biopsy with formalin-fixed paraffin-embedded (FFPE) tissue submitted to the molecular pathology laboratory. The oncologist requests testing for NTRK1 gene rearrangements to identify tropomyosin receptor kinase (TRK) fusions that may be actionable for targeted therapy. Laboratory workflow: specimen accessioning → review of clinical indication and specimen adequacy → extraction of nucleic acid from FFPE tissue → performance of the validated molecular assay targeting NTRK1 translocations (technical component) → bioinformatics analysis and generation of raw results (technical output) → pathologist or molecular director performs interpretation and issues a report (professional component, billed separately when applicable). Typical site of service is an independent clinical molecular laboratory, hospital-based pathology laboratory, or reference laboratory with specimens received from outpatient oncology clinics, hospital inpatient services, or surgical pathology departments.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the professional interpretation component separate from the laboratory (technical) work |
TC |