Summary & Overview
CPT 81207: BCR‑ABL1 Minor Breakpoint Molecular Test
CPT code 81207 covers molecular testing for the minor breakpoint BCR/ABL1 fusion gene associated with BCR-ABL1 translocation on chromosome 22. This assay can be performed qualitatively to detect the presence of the minor breakpoint fusion or quantitatively to measure transcript levels. The test is clinically important for diagnosis, monitoring, and therapeutic decision-making in disorders where BCR-ABL1 variants are relevant.
Key payers in the national analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The summary addresses coverage and coding context for major commercial payers and the Medicare program.
Readers will learn the clinical purpose of the assay, typical sites of service, and what to expect in payer coverage discussion: which stakeholders commonly cover this molecular diagnostic, common billing modifiers used in practice, and the clinical contexts in which the test is ordered. The publication provides benchmarks and policy-relevant guidance on coding and service characterization, clinical background on the minor BCR/ABL1 breakpoint, and a concise reference for billing staff and laboratory managers. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 81207 describes laboratory testing to evaluate the minor breakpoint BCR/ABL1 fusion gene on chromosome 22 resulting from the BCR-ABL1 translocation. The procedure covers both qualitative testing to detect the presence of the minor breakpoint fusion and quantitative testing to measure the amount of fusion transcript when present.
Service type: Molecular pathology / genetic diagnostic testing
Typical site of service: Clinical laboratory or hospital laboratory
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 45-year-old patient with a history of chronic myeloid leukemia (CML) presents for molecular monitoring of disease burden after initiation of targeted therapy. A peripheral blood specimen is sent to the molecular diagnostics laboratory to detect and/or quantify the BCR-ABL1 fusion transcript arising from the minor breakpoint on chromosome 22. The workflow begins with specimen collection (EDTA whole blood), accessioning, RNA extraction, reverse transcription, and either qualitative PCR to confirm presence of the minor BCR-ABL1 fusion or quantitative real-time PCR to measure transcript levels for treatment monitoring. The laboratory analyst performs the technical component of the assay, runs appropriate controls, interprets amplification curves, and reports either a positive/negative result (qualitative) or ratio/IS (International Scale) value (quantitative). Results are routed to the ordering hematologist/oncologist and incorporated into clinical decisions about therapy response and need for therapy adjustment or additional diagnostic testing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician interpretation/reporting portion separate from the technical lab component |
TC |