CPT 81195: Optical Genome Mapping for Hematologic Malignancy

CPT code 81195 covers optical genome mapping for genome‑wide cytogenomic analysis to identify structural variants and copy number variants linked to hematologic malignancies. This emerging laboratory technology offers a comprehensive alternative to conventional cytogenetics and chromosomal microarray for detecting large structural alterations across the genome. Nationally, adoption of advanced genome‑wide structural variant testing influences specialty oncology diagnostics, laboratory service lines, and payer coverage policies.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical role of optical genome mapping in hematologic cancer evaluation, typical sites of service, and the coding context for laboratory billing. The publication summarizes benchmark considerations for utilization and reimbursement and highlights relevant policy and payer coverage trends that affect access to genome‑wide cytogenomic testing.

The content provides clinical context for when genome‑wide structural variant analysis is used in hematology, explains service classification for billing purposes, and outlines what stakeholders should know about payer coverage environments and typical laboratory deployment. Data not available in the input is noted where applicable.

Customize your policy alerts

Sign up for cpt 81195 policy alerts

Get alerted when payer policies referencing 81195 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

CPT code 81195 describes an optical genome mapping laboratory service performed for cytogenomic (genome‑wide) analysis to detect structural variants and copy number variants associated with hematologic malignancy. This is a specialized molecular cytogenetics test that evaluates the genome broadly for large-scale structural changes rather than targeted single‑gene mutations.

Service type: Laboratory — molecular cytogenomic testing using optical genome mapping

Typical site of service: Clinical laboratory or reference laboratory

Explore openpayer tools

View all tools

CPT 81195: Optical Genome Mapping for Hematologic Malignancy

Customize your policy alerts

Sign up for cpt 81195 policy alerts

Get alerted when payer policies referencing 81195 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

Service type: Laboratory — molecular cytogenomic testing using optical genome mapping

Typical site of service: Clinical laboratory or reference laboratory

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient with newly diagnosed acute myeloid leukemia (AML) presents for baseline molecular and cytogenomic workup. Peripheral blood and a bone marrow aspirate are submitted to the molecular pathology laboratory. The lab performs optical genome mapping to detect genome-wide structural variants and copy number variants that are relevant to hematologic malignancies, aiding risk stratification and treatment planning. The clinical workflow includes specimen collection and accessioning, nucleic acid extraction and high molecular weight DNA isolation, optical genome mapping analysis, bioinformatics interpretation to detect translocations, large insertions/deletions, and copy number changes, and generation of a report integrated with conventional cytogenetics and molecular testing. Results are routed to the ordering hematologist-oncologist and entered into the electronic medical record for multidisciplinary tumor board review.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C92.0`	Acute myeloblastic leukemia with t(8;21)(q22;q22)	Structural rearrangements and copy number variants are critical for subclassification and prognosis.
`C92.1`	Acute myelomonocytic leukemia	Genome-wide mapping detects structural variants informing diagnosis and therapeutic decisions.
`C94.6`	Myelodysplastic disease with (excess) blast	Structural and copy number variants guide risk stratification and treatment planning.
`C88.4`	Waldenström macroglobulinemia	Structural genomic alterations can affect prognosis and targeted therapy choices.
`C91.9`	Lymphoid leukemia, unspecified	Broad genomic analysis helps identify underlying structural drivers when subtyping is unclear.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`88182`	Flow cytometry, diagnostic; initial panel, up to 8 markers, for leukemia/lymphoma immunophenotyping	Often performed alongside to phenotype malignant cells and support diagnosis that guides genomic testing.
`81205`	BCR-ABL1 (e.g., t(9;22)) quantitative or qualitative test (example molecular test)	Targeted molecular tests for common translocations may be performed before or after genome-wide mapping to confirm specific rearrangements.
`81206`	JAK2 (V617F) mutation analysis	Frequently ordered in evaluation of myeloproliferative neoplasms and may complement genome-wide structural assessments.
`88235`	Chromosome analysis; bone marrow (karyotype)	Conventional cytogenetics is commonly performed in parallel for detection of structural rearrangements and to correlate with optical mapping findings.
`81479`	Unlisted molecular pathology procedure	Used for reporting other molecular tests or adjunctive assays not described by specific CPT codes when performed with genome-wide mapping.

Related Modifiers

9 rows

Modifier	Description	When to Use
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
90	Modifier ‑90 (Reference/Outside Laboratory) indicates that a laboratory test was performed by an entity other than the treating or reporting provider. The American Medical Association defines…	- Use CPT modifier -90 when a laboratory test is performed by an outside/reference laboratory (an entity other than the treating or reporting physician or qualified professional) and the claim needs…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
363A00000X	Physician Assistant	A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and…
207RG0100X	Gastroenterology Physician	An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This…
207P00000X	Emergency Medicine Physician	An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospit…
208D00000X	General Practice Physician	A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
374J00000X	Doula	Doulas work in a variety of settings and have been trained to provide physical, emotional, and informational support to a mother before, during, and j…
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
103TB0200X	Cognitive & Behavioral Psychologist	A psychologist who reflects an experimental-clinical approach distinguished by use of principles of human learning and development and theories of cog…
207RH0000X	Hematology (Internal Medicine) Physician	An internist with additional training who specializes in diseases of the blood, spleen and lymph. This specialist treats conditions such as anemia, cl…

CPT 81105: HPA-1 (CD61/ITGB3) Platelet Antigen Genotyping

CPT-81106-HPA-2-T145M-GENETIC-ALLELE-ANALYSIS

CPT 81106: HPA-2 (T145M) Genetic Allele Analysis

CPT-81107-HPA-3-GENETIC-ANALYSIS-TECHNICAL-COMPONENT

CPT 81107: HPA‑3 (I843S) Platelet Antigen Genotyping

CPT-81108-HPA-4-R143Q-GENOTYPING

CPT 81108: HPA-4 (R143Q) Genotyping, Technical Component

CPT-81109-HPA-5-K505E-GENETIC-ANALYSIS

CPT 81109: HPA-5 (K505E) Genetic Analysis

CPT-81110-HPA-6-R489Q-GENOTYPING

CPT 81110: HPA-6 (R489Q) Genotyping, Technical Component

CPT-81111-HPA-9-V837M-ALLELE-ANALYSIS

CPT 81111: HPA-9 (V837M) Allele Analysis, Laboratory Technical Component

CPT-81112-HPA-15-GENETIC-ANALYSIS-S682Y

CPT 81112: HPA-15 (S682Y) Genetic Analysis

CPT-81120-IDH1-MOLECULAR-DIAGNOSTIC-TEST

CPT 81120: IDH1 Molecular Diagnostic Test

CPT-81121-IDH2-MOLECULAR-DIAGNOSTIC-TEST

CPT 81121: IDH2 (NADP+) Molecular Diagnostic Test

Showing 1–10 of 199

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Explore openpayer tools

View all tools

Clinical & Coding Specifications

Clinical Context

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C92.0`	Acute myeloblastic leukemia with t(8;21)(q22;q22)	Structural rearrangements and copy number variants are critical for subclassification and prognosis.
`C92.1`	Acute myelomonocytic leukemia	Genome-wide mapping detects structural variants informing diagnosis and therapeutic decisions.
`C94.6`	Myelodysplastic disease with (excess) blast	Structural and copy number variants guide risk stratification and treatment planning.
`C88.4`	Waldenström macroglobulinemia	Structural genomic alterations can affect prognosis and targeted therapy choices.
`C91.9`	Lymphoid leukemia, unspecified	Broad genomic analysis helps identify underlying structural drivers when subtyping is unclear.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`88182`	Flow cytometry, diagnostic; initial panel, up to 8 markers, for leukemia/lymphoma immunophenotyping	Often performed alongside to phenotype malignant cells and support diagnosis that guides genomic testing.
`81205`	BCR-ABL1 (e.g., t(9;22)) quantitative or qualitative test (example molecular test)	Targeted molecular tests for common translocations may be performed before or after genome-wide mapping to confirm specific rearrangements.
`81206`	JAK2 (V617F) mutation analysis	Frequently ordered in evaluation of myeloproliferative neoplasms and may complement genome-wide structural assessments.
`88235`	Chromosome analysis; bone marrow (karyotype)	Conventional cytogenetics is commonly performed in parallel for detection of structural rearrangements and to correlate with optical mapping findings.
`81479`	Unlisted molecular pathology procedure	Used for reporting other molecular tests or adjunctive assays not described by specific CPT codes when performed with genome-wide mapping.

Related Modifiers

9 rows

Modifier	Description	When to Use
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
90	Modifier ‑90 (Reference/Outside Laboratory) indicates that a laboratory test was performed by an entity other than the treating or reporting provider. The American Medical Association defines…	- Use CPT modifier -90 when a laboratory test is performed by an outside/reference laboratory (an entity other than the treating or reporting physician or qualified professional) and the claim needs…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
363A00000X	Physician Assistant	A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and…
207RG0100X	Gastroenterology Physician	An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This…
207P00000X	Emergency Medicine Physician	An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospit…
208D00000X	General Practice Physician	A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
374J00000X	Doula	Doulas work in a variety of settings and have been trained to provide physical, emotional, and informational support to a mother before, during, and j…
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
103TB0200X	Cognitive & Behavioral Psychologist	A psychologist who reflects an experimental-clinical approach distinguished by use of principles of human learning and development and theories of cog…
207RH0000X	Hematology (Internal Medicine) Physician	An internist with additional training who specializes in diseases of the blood, spleen and lymph. This specialist treats conditions such as anemia, cl…

CPT 81105: HPA-1 (CD61/ITGB3) Platelet Antigen Genotyping

CPT-81106-HPA-2-T145M-GENETIC-ALLELE-ANALYSIS

CPT 81106: HPA-2 (T145M) Genetic Allele Analysis

CPT-81107-HPA-3-GENETIC-ANALYSIS-TECHNICAL-COMPONENT

CPT 81107: HPA‑3 (I843S) Platelet Antigen Genotyping

CPT-81108-HPA-4-R143Q-GENOTYPING

CPT 81108: HPA-4 (R143Q) Genotyping, Technical Component

CPT-81109-HPA-5-K505E-GENETIC-ANALYSIS

CPT 81109: HPA-5 (K505E) Genetic Analysis

CPT-81110-HPA-6-R489Q-GENOTYPING

CPT 81110: HPA-6 (R489Q) Genotyping, Technical Component

CPT-81111-HPA-9-V837M-ALLELE-ANALYSIS

CPT 81111: HPA-9 (V837M) Allele Analysis, Laboratory Technical Component

CPT-81112-HPA-15-GENETIC-ANALYSIS-S682Y

CPT 81112: HPA-15 (S682Y) Genetic Analysis

CPT-81120-IDH1-MOLECULAR-DIAGNOSTIC-TEST

CPT 81120: IDH1 Molecular Diagnostic Test

CPT-81121-IDH2-MOLECULAR-DIAGNOSTIC-TEST

CPT 81121: IDH2 (NADP+) Molecular Diagnostic Test

Showing 1–10 of 199

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 81195: Optical Genome Mapping for Hematologic Malignancy

Sign up for cpt 81195 policy alerts

Billing Code Overview

OpenPayer

CPT 81195: Optical Genome Mapping for Hematologic Malignancy

Sign up for cpt 81195 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Related Diagnoses

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related Diagnoses

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References