Summary & Overview
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.
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
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.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the professional (interpretation) component separate from the technical component. |
TC | Technical component | Use when reporting only the technical component (laboratory processing and analysis) separate from the professional component. |