Summary & Overview
CPT 81262: IGH@ Clonality Detection by Direct Probe
CPT code 81262 covers a molecular laboratory assay that detects clonal immunoglobulin heavy chain (IGH@) gene rearrangements using direct probe techniques to identify B‑cell clonality. This test is clinically significant for diagnosing and monitoring lymphoid neoplasms, including various B‑cell lymphomas and leukemias, because detection of a clonal IGH@ population can confirm a neoplastic process and guide subsequent clinical decision-making. Nationally, molecular clonality testing is an important component of hematopathology services provided by hospital and reference laboratories.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context, typical sites of service, and an explanation of what CPT code 81262 represents. The publication also covers payer coverage considerations and common billing modifiers (listed separately), as well as benchmarking and policy implications where available. The goal is to provide clinicians, laboratory managers, and billing professionals a concise reference for the code’s clinical purpose, expected setting, and the types of documentation that typically accompany claims.
Billing Code Overview
CPT code 81262 describes a laboratory procedure that uses direct probe methods to detect clonal populations from gene rearrangements in the Immunoglobulin heavy chain locus (IGH@). The test identifies clonal B-cell populations that are indicative of lymphoid neoplasms, supporting diagnosis, staging, or monitoring of hematologic malignancies.
Service type: Molecular diagnostic / laboratory hematopathology test
Typical site of service: Clinical laboratory or hospital-based molecular diagnostics laboratory
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Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with persistent lymphadenopathy and unexplained cytopenias is referred for hematologic evaluation. A hematologist obtains peripheral blood and/or bone marrow specimens to evaluate for a suspected B‑cell lymphoid neoplasm. The clinical laboratory performs molecular testing using direct probe methods targeting the Immunoglobulin heavy chain locus (IGH@) to detect clonal B‑cell populations indicative of lymphoma or chronic lymphocytic leukemia. The typical workflow includes specimen accessioning, DNA extraction, performance of the direct probe assay (technical component), interpretation by a molecular pathologist (professional component when billed separately), documentation of results in the laboratory information system, and communication of findings to the ordering clinician for treatment planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the professional (interpretation) portion performed by a physician or qualified healthcare professional separate from the laboratory technical component. |
| TC | Technical component | Use when reporting only the laboratory technical component of the test (equipment, reagents, technician time) and the performing entity is billing for the technical service.