Summary & Overview
CPT 81275: KRAS Exon 2 Mutation Analysis
CPT code 81275 represents a targeted molecular test for common mutations in the KRAS gene within exon 2. This genetic assay is widely used in oncology to characterize tumor genotypes that can affect prognosis and eligibility for certain targeted therapies. Nationally, KRAS testing is a routine component of molecular diagnostic workflows for cancers such as colorectal and non-small cell lung cancer, making CPT code 81275 relevant to payers, laboratories, and oncology practices.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes coverage and coding considerations across major national payers and Medicare, highlights clinical context and typical use cases, and outlines what readers can expect to find in the full report.
Readers will learn practical benchmarks and policy-relevant information: typical sites of service and clinical scenarios where the test is applied; payer coverage landscape and common coding considerations; and how CPT code 81275 fits into molecular diagnostic service lines. Data not available in the input is noted explicitly where applicable. The content is intended for laboratory administrators, coding professionals, and policy analysts seeking a concise national-level briefing on CPT code 81275.
Billing Code Overview
CPT code 81275 describes a laboratory molecular diagnostic test that detects common mutations in the KRAS gene, specifically targeting changes in exon 2. The service is a genetic mutation analysis performed by a clinical laboratory to identify oncogenic variants in the Kirsten rat sarcoma viral oncogene homolog.
Service type: Laboratory — molecular pathology / targeted mutation analysis
Typical site of service: Clinical laboratory or hospital laboratory; specimens collected in outpatient or inpatient settings and processed in a centralized testing laboratory
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with metastatic colorectal adenocarcinoma undergoes tumor genotyping to guide targeted therapy selection. A tissue biopsy or circulating tumor DNA sample is sent to a molecular diagnostics laboratory. The laboratory performs technical analysis to detect common hotspot mutations in the KRAS gene specifically in exon 2 (codons 12 and 13). Results inform oncologist decision-making about use of anti-EGFR monoclonal antibodies and enrollment in targeted therapy trials. Typical workflow: sample collection at an outpatient oncology infusion center or hospital pathology department; specimen accessioning and nucleic acid extraction in the molecular lab; performance of the analytic assay (sequencing or PCR-based hotspot test) billed under 81275; result verification by a pathologist or molecular geneticist and issuance of a clinical report to the ordering oncologist. Typical site of service: clinical molecular diagnostics laboratory processing specimens from outpatient oncology clinics, hospital inpatient services, or reference labs.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation component of a split technical/professional service if applicable for molecular test reporting. |