Summary & Overview
CPT 81310: NPM1 Gene Mutation Detection, Molecular Diagnostic Test
CPT code 81310 represents a molecular diagnostic test that detects mutations in the NPM1 (nucleophosmin) gene. NPM1 mutation testing is clinically important for diagnosis, prognosis, and disease classification in certain hematologic malignancies, influencing treatment selection and risk stratification nationally. The code covers the laboratory technical component of performing the assay to identify specific genetic changes in NPM1.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for NPM1 testing, standard sites of service, and the scope of billing activity associated with this molecular assay. The publication outlines national benchmarks and coverage considerations, summarizes relevant policy activity affecting molecular diagnostic claims, and provides operational details useful for billing and compliance teams. Data gaps in the input are noted where specific payer policies or utilization metrics are not provided.
Billing Code Overview
CPT code 81310 describes a laboratory assay performed by a lab analyst to detect specific changes in the NPM1 (nucleophosmin) gene. This test identifies sequence alterations in NPM1 that are clinically relevant for hematologic malignancies.
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Service type: Molecular diagnostic genetic test
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Typical site of service: Clinical laboratory or hospital laboratory (reference/diagnostic laboratory setting)
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or pediatric patient with suspected or confirmed acute myeloid leukemia (AML) or another myeloid neoplasm undergoing molecular diagnostic testing to detect mutations in the nucleophosmin gene (NPM1). The clinician (hematologist/oncologist) orders the test when bone marrow aspiration or peripheral blood shows blasts or abnormal myeloid maturation, when treatment decisions depend on mutational status, or for minimal residual disease assessment following induction therapy. A specimen (bone marrow aspirate or peripheral blood) is collected in appropriate tubes and sent to a molecular pathology or clinical laboratory. The laboratory analyst performs the technical assay (often PCR-based or next-generation sequencing) to detect NPM1 variants. Results are interpreted by a pathologist or molecular geneticist and reported to the ordering provider to guide prognosis, risk stratification, and therapeutic choices.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician interpretation component separate from the technical lab work (rare for this molecular test). |
TC | Technical component |