Summary & Overview
CPT 81264: IGK Clonality Assay for Lymphoid Neoplasm Detection
CPT code 81264 denotes a molecular diagnostic laboratory procedure that detects clonal rearrangements in the Immunoglobulin kappa light chain locus (IGK@), used to identify clonal B‑cell populations associated with lymphoid neoplasms. This assay supports diagnostic evaluation and disease monitoring in hematopathology and oncology, informing treatment planning and prognostic assessment. Nationally, utilization of clonal IGK testing is relevant to cancer centers, community hospitals, and reference laboratories due to its role in confirming lymphoid malignancies and guiding subsequent care.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical context, common sites of service, and the laboratory nature of the work. The publication provides benchmarking and payment context where available, highlights recent policy or coverage considerations affecting molecular clonality testing, and summarizes coding and billing implications relevant to laboratory and pathology services. The content is designed for laboratory managers, billing professionals, and clinical leaders seeking a national perspective on the use and billing of CPT code 81264 in the evaluation of suspected lymphoid neoplasms.
Billing Code Overview
CPT code 81264 describes a laboratory molecular diagnostic test that detects clonal populations from gene rearrangements within the Immunoglobulin kappa light chain locus (IGK@). The procedure identifies the presence of clonal B‑cell populations that are indicative of lymphoid neoplasms.
Service type: Laboratory — molecular pathology / molecular diagnostic assay
Typical site of service: Clinical laboratory or hospital laboratory (inpatient/outpatient blood or tissue specimen processing)
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Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with persistent lymphadenopathy and unexplained cytopenias is evaluated for suspected B-cell lymphoproliferative disorder. The hematologist orders molecular clonality testing to detect clonal immunoglobulin kappa light chain (IGK@) gene rearrangements. A peripheral blood or bone marrow specimen is collected and sent to a molecular diagnostics laboratory. The lab technologist performs DNA extraction, PCR-based or next-generation sequencing-based assays specific to the IGK locus, and analytical interpretation to determine presence or absence of a clonal B-cell population. Results are reported to the ordering clinician to help distinguish reactive lymphoid proliferations from clonal lymphoid neoplasms and to guide further diagnostic workup such as flow cytometry, immunohistochemistry, cytogenetics, or targeted therapy selection.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the physician or pathologist interpretation component separate from the technical lab work |
TC | Technical component | When billing only the laboratory technical component separate from the professional interpretation |