Summary & Overview
CPT 81305: MYD88 p.Leu265Pro (L265P) Targeted Molecular Detection
CPT code 81305 designates a targeted molecular diagnostic test to detect the p.Leu265Pro (L265P) variant in the MYD88 gene. This assay is used in clinical contexts where identification of MYD88 L265P informs diagnosis, prognosis, or disease classification, notably in hematologic disorders. Nationally, accurate coding for such molecular tests supports appropriate clinical decision-making and consistent reporting across laboratories.
Key payers included in this coverage analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The discussion addresses payer coverage patterns and clinical context relevant to molecular oncology and hematopathology testing.
Readers will find a concise explanation of the clinical purpose of CPT code 81305, the typical laboratory setting where the technical component is performed, and the primary clinical scenarios in which detection of MYD88 L265P is relevant. The publication outlines common modifiers and practical billing considerations, summarizes expected sites of service, and highlights where data was not available in the input. The content is designed for billing managers, laboratory directors, and policy analysts seeking clear information on coding and clinical context for MYD88 L265P targeted testing.
Billing Code Overview
CPT code 81305 describes a laboratory molecular test that detects specific alterations in the myeloid differentiation primary response 88 gene (MYD88), specifically targeting the p.Leu265Pro (L265P) variant. This service represents the technical laboratory component of a targeted genetic assay performed by a laboratory analyst to determine the presence of a clinically relevant somatic or germline change in the MYD88 gene.
Service type: Molecular diagnostic testing (targeted variant detection)
Typical site of service: Clinical molecular laboratory or hospital clinical lab (inpatient or outpatient laboratory setting)
Clinical & Coding Specifications
Clinical Context
A 72-year-old patient with suspected Waldenström macroglobulinemia (WM) presents with anemia, hyperviscosity symptoms, and an elevated monoclonal IgM. The hematologist orders molecular testing to detect the MYD88 p.Leu265Pro (L265P) somatic variant to support diagnosis and guide therapy. A peripheral blood or bone marrow aspirate sample is collected in the outpatient hematology clinic or hospital laboratory and sent to a molecular diagnostics laboratory. The lab technologist performs the technical assay — often allele-specific PCR or targeted NGS — to detect the MYD88 L265P mutation. The laboratory issues a report documenting presence or absence of the variant; the professional component review and interpretation are provided by a board-certified molecular pathologist who signs the final report. Typical sites of service include hospital laboratories, independent reference laboratories, and outpatient clinic specimen collection rooms.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the interpretation/reporting by the pathologist for the molecular test. |
TC | Technical component | Use when billing only the laboratory technical component (instrumentation, reagents, tech time). |