Summary & Overview
CPT 81277: Genomic CNV and LOH Analysis for Cancer
CPT code 81277 represents a laboratory genomic assay that analyzes tumor tissue or blood specimens from cancer patients to detect copy number variants (CNV) and chromosomal markers such as loss of heterozygosity (LOH). These genomic features inform tumor characterization, prognostic assessment, and selection of targeted therapies or clinical trial eligibility, making the test clinically significant across oncology care.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines coverage and reimbursement benchmarks, clinical context for use in oncology workflows, and relevant policy updates impacting molecular diagnostic services at a national level.
Readers will find a concise explanation of the clinical purpose and typical laboratory workflow for CPT code 81277, summaries of payer coverage approaches and common billing practices, and comparisons to related molecular testing categories. The report also highlights implications for laboratory operations and coding compliance. Data not available in the input are identified where applicable, and the content focuses on national-level policy and clinical context rather than state-specific rules.
Billing Code Overview
CPT code 81277 describes a laboratory assay that evaluates a cancer patient’s genome for copy number variants (CNV) and chromosomal markers such as loss of heterozygosity (LOH) using tumor tissue or blood specimens. The procedure involves laboratory technical analysis to detect variations in the number of copies of gene sequences and long runs of homozygosity that can indicate chromosomal abnormalities relevant to oncology.
Service type: Comprehensive genomic laboratory test for CNV and chromosomal markers
Typical site of service: Clinical laboratory or centralized molecular pathology laboratory, using specimens collected from outpatient clinics, hospital inpatient settings, or specialized oncology centers.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a history of high-grade serous ovarian carcinoma undergoes tumor profiling after progression on first-line chemotherapy. A tissue biopsy is obtained and sent to the molecular diagnostics laboratory. The lab analyst performs comprehensive genomic analysis to detect copy number variants (CNVs), loss of heterozygosity (LOH), and chromosomal-level alterations across the genome using next-generation sequencing and bioinformatic pipelines. Results are reported to the ordering oncologist to inform targeted therapy decisions, eligibility for clinical trials, or prognostic assessment. Typical workflow steps include specimen accessioning, DNA extraction from formalin-fixed paraffin-embedded tumor tissue or circulating tumor DNA from a blood specimen, library preparation, sequencing, bioinformatic CNV and LOH calling, technical review by the laboratory, and issuance of a finalized molecular report. Typical site of service is an outpatient pathology or molecular diagnostics laboratory, often associated with an academic medical center or reference laboratory. Common payer interactions include prior authorization for genomic testing and transmission of the technical component billing to the performing laboratory while professional interpretation may be billed separately by the pathologist or molecular geneticist.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the professional interpretation component if separated from the laboratory technical component |