Summary & Overview
CPT 81245: FLT3 Internal Tandem Duplication (ITD) Molecular Test
CPT code 81245 represents a laboratory molecular test to detect internal tandem duplication (ITD) variants in the FLT3 gene. FLT3-ITD alterations are clinically significant in certain hematologic malignancies because they inform prognosis and can guide targeted treatment decisions. As molecular diagnostics are increasingly central to personalized oncology care, accurate coding and coverage practices for tests like CPT code 81245 matter for access, billing consistency, and care coordination nationwide.
Key payers addressed 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 FLT3-ITD testing, how the service is typically delivered in laboratory settings, and what to expect in payer coverage terms. The publication also presents benchmarks and policy-relevant points about reimbursement coding, common modifiers used with laboratory services, and potential documentation considerations. This summary equips billing managers, laboratory directors, and clinicians with the foundational information needed to navigate coverage and billing for CPT code 81245 at a national level.
Billing Code Overview
CPT code 81245 describes a molecular diagnostic laboratory test that detects specific changes in the FLT3 (fms related tyrosine kinase 3) gene, specifically internal tandem duplication (ITD) variants. The service is a laboratory genetic test performed by a clinical laboratory analyst to identify the presence of FLT3-ITD alterations, which can inform diagnosis, prognosis, and targeted therapy decisions in hematologic malignancies.
The service type is molecular pathology / genetic testing. The typical site of service is a clinical laboratory or an accredited molecular diagnostics laboratory that performs specialized genetic assays.
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Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with newly diagnosed acute myeloid leukemia (AML) is referred for molecular testing to characterize prognostic and treatment-directed mutations. A bone marrow aspirate or peripheral blood specimen is submitted to the molecular diagnostics laboratory. The laboratory performs targeted testing to detect internal tandem duplication (ITD) variants in the fms related tyrosine kinase 3 gene (FLT3). Results inform prognosis and eligibility for FLT3-directed therapies and clinical trial enrollment. The clinical workflow includes: specimen collection and accessioning, DNA extraction, PCR-based or next-generation sequencing assay specific for FLT3-ITD, bioinformatic analysis, technical and clinical validation, and reporting to the ordering hematologist/oncologist. Turnaround time is typically 3–7 calendar days depending on method and laboratory capacity.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the professional component of the test interpretation by the physician/pathologist separate from the laboratory technical component. |