Summary & Overview
CPT 81278: IGH@/BCL2 Translocation (t(14;18)) MBR and mcr Analysis
CPT code 81278 covers molecular diagnostic testing for IGH@/BCL2 translocations (t(14;18)) targeting major breakpoint region (MBR) and minor cluster region (mcr) rearrangements. This assay is clinically important for the detection and characterization of follicular lymphoma and related B-cell neoplasms; accurate laboratory identification can influence diagnosis, staging, and therapeutic decision-making at a national level. Payers commonly involved in coverage and claims for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find an overview of the clinical context for using 81278, typical sites of service, common billing modifiers, and what is known about payer handling and coverage considerations. The publication provides benchmarks for utilization and reimbursement patterns where available, summaries of payer policy trends affecting molecular translocation testing, and practical notes on documentation and coding clarity relevant to laboratories and billing teams. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 81278 describes a laboratory molecular diagnostic assay that detects translocation major breakpoint region (MBR) and minor cluster region (mcr) rearrangements involving IGH@/BCL2 (t(14;18)). The test is performed on specimens such as blood, formalin–fixed paraffin embedded tissue (FFPE), or bone marrow.
Service type: Molecular pathology/translocation analysis performed by a clinical laboratory technician or molecular analyst.
Typical site of service: Clinical laboratory or hospital laboratory performing molecular diagnostic testing on patient specimens.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with progressive lymphadenopathy and constitutional symptoms undergoes an excisional lymph node biopsy. Histopathology suggests a B-cell lymphoma, and the hematopathologist orders molecular testing to evaluate for IGH@/BCL2 translocation (t(14;18)). A paraffin-embedded tissue block (FFPE) from the biopsy is sent to the molecular diagnostics laboratory. The laboratory technologist performs a fluorescence in situ hybridization (FISH) or PCR-based translocation analysis targeting the IGH@/BCL2 major and minor breakpoint regions to detect the t(14;18) event associated with follicular lymphoma.
The typical clinical workflow includes specimen accessioning, review of clinical indication and previous pathology, microtomy to prepare slides from FFPE or extraction of nucleic acid from fresh/frozen tissue or bone marrow, performance of the translocation assay (technical component), interpretation by a pathologist (professional component if billed separately), and reporting of results to the treating hematologist/oncologist. Resulting detection of IGH@/BCL2 informs diagnosis, prognosis, and may influence therapeutic planning for follicular lymphoma.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing the interpretation/reporting component by the pathologist separate from the technical lab work. |