CPT 81287 MGMT Promoter Methylation Reimbursement

CPT code 81287 denotes MGMT promoter methylation analysis, a molecular pathology test used primarily as a prognostic and predictive biomarker in glioblastoma care. Nationally, this test influences chemotherapy decision-making for patients considered for alkylating agents such as temozolomide and factors into personalized oncology workflows and care pathways. Payers commonly relevant to coverage and policy review include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

This publication provides a concise overview of clinical context and coding for CPT code 81287, plus operational benchmarks and policy-relevant considerations. Readers will find: a clinical summary of the test's role in neuro-oncology; typical sites of service and laboratory settings; payer coverage landscape and common billing modifiers used with molecular pathology services; and key items for billing and documentation workflows. The report is intended for billing managers, laboratory directors, oncology clinical teams, and policy analysts seeking a national-level briefing on MGMT promoter methylation testing and its implications for coding and payer interactions.

Billing Code Overview

CPT code 81287 describes O-6-methylguanine-DNA methyltransferase (MGMT) promoter methylation analysis, a molecular pathology test that assesses methylation status of the MGMT gene promoter. This assay is used primarily as a prognostic and predictive marker for glioblastoma and other central nervous system tumors to inform likely responsiveness to alkylating chemotherapy such as temozolomide.

Service Type: Molecular pathology / tumor biomarker testing

Typical Site of Service: Hospital-based or independent clinical laboratory; outpatient oncology clinics for specimen collection

Data not available in the input.

Clinical Context

A 58-year-old patient presents after surgical resection of a high-grade intracranial neoplasm. Neurosurgery submits formalin-fixed, paraffin-embedded tumor tissue for molecular profiling to guide adjuvant therapy. The pathology team orders O-6-methylguanine-DNA methyltransferase promoter methylation analysis (81287) to determine MGMT promoter methylation status, which helps predict responsiveness to alkylating agents such as temozolomide. The typical workflow: tissue is accessioned by the histology lab, a molecular pathology or reference lab extracts DNA from tumor-rich blocks, performs methylation-specific PCR or pyrosequencing, and reports methylated versus unmethylated status with interpretation added to the pathology report. Results are reviewed by neuro-oncology and pathology to inform prognosis and chemotherapy selection.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when reporting only the professional interpretive service for the molecular test if the laboratory separates technical and professional components.
`TC`	Technical component

Taxonomy Code	Specialty	Notes
207RP0200X	Pathology	Anatomic and clinical pathologists supervise molecular testing and interpret results.
207RH0000X	Hematology/Oncology	Medical oncologists use MGMT results to guide chemotherapy decisions in gliomas.
2084P0800X	Surgical Neurology	Neurosurgeons obtain tissue and coordinate molecular testing for resected brain tumors.
207N00000X	Neurology	Neurologists and neuro-oncologists incorporate results into longitudinal care planning.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C71.9`	Malignant neoplasm of brain, unspecified	Primary high-grade gliomas (e.g., glioblastoma) for which MGMT methylation predicts temozolomide response.
`D43.0`	Neoplasm of uncertain behavior of brain, unspecified	Used when tumor behavior is uncertain; molecular testing informs prognosis and management.
`C71.1`	Malignant neoplasm of frontal lobe	Anatomic site-specific code for brain tumors where MGMT testing is applied to guide therapy.
`C71.2`	Malignant neoplasm of temporal lobe	Site-specific malignant brain tumor commonly evaluated with MGMT methylation testing.
`C71.3`	Malignant neoplasm of parietal lobe	Another intracranial site where MGMT status impacts adjuvant chemotherapy decisions.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`88384`	Immunohistochemistry, per single antibody stain, including controls, any type of method	Used on tumor tissue to evaluate protein expression (e.g., ATRX, IDH1 R132H) that complements molecular profiling.
`88342`	Morphometric analysis, tumor cell quantification (eg, tumor cellularity estimation)	Performed by pathology to estimate tumor cellularity before molecular testing to ensure sufficient tumor for `81287`.
`88363`	Morphometric analysis, immunohistochemical or special stains, quantitative, single field	Used in specialized quantitative assessments supporting molecular interpretation.
`81479`	Unlisted molecular pathology procedure	Occasionally used for novel or custom molecular assays not otherwise described; not routinely used when `81287` applies.
`81312`	`IDH1` and `IDH2` mutation analysis (molecular pathology)	Often ordered alongside MGMT methylation to fully characterize molecular profile of gliomas and inform prognosis.

OpenPayer

Summary & Overview

CPT 81287: MGMT Promoter Methylation Analysis