Summary & Overview
CPT 81345: Targeted Genetic Testing of TERT Promoter
Headline: New CPT code 81345 captures targeted laboratory analysis of genes including the TERT promoter. Lead: CPT code 81345 designates the technical laboratory component for targeted genetic analysis, such as assessment of the telomerase reverse transcriptase (TERT) promoter region, and is relevant for molecular diagnostics across oncology and genetic risk assessment.
CPT code 81345 represents the technical processing and analysis of targeted gene regions. Nationally, this code matters because targeted molecular assays inform diagnosis, prognosis, and therapeutic decision-making in oncology and inherited disease evaluation. Labs and payers use this code to bill for the technical portion of specialized molecular tests that do not necessarily include interpretation or clinical correlation.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for targeted genetic testing, typical sites of service, common modifiers associated with laboratory technical services, and where available, payer coverage considerations. The publication outlines benchmarks and coding guidance, highlights policy updates affecting molecular test billing, and situates 81345 within broader genomic testing workflows.
This summary is intended for laboratory billing managers, medical coders, and health policy analysts seeking a national perspective on how CPT code 81345 is used and reimbursed in clinical molecular diagnostics.
Billing Code Overview
CPT code 81345 describes a technical laboratory test performed by a lab analyst to analyze targeted genes, including the promoter region of the telomerase reverse transcriptase gene (TERT). The service involves laboratory processing and analytic steps to detect specific genetic alterations in targeted genomic regions.
-
Service type: Targeted molecular genetic testing (technical component)
-
Typical site of service: Clinical laboratory or hospital laboratory performing molecular diagnostic testing
Clinical & Coding Specifications
Clinical Context
A patient presents with a suspicious skin lesion on the head or neck or with an indeterminate brain tumor specimen where assessment of telomerase reverse transcriptase (TERT) promoter mutations will inform diagnosis, prognosis, or molecular classification. The patient is typically referred by a dermatology, oncology, neurosurgery, or pathology provider after initial histopathology or imaging raises concern for malignancy. A tissue sample (biopsy or resection specimen) or a previously extracted DNA sample is submitted to a molecular diagnostics laboratory. The laboratory analyst performs the technical assay identified by 81345, targeting the promoter region of the TERT gene to detect activating mutations (commonly C228T and C250T). Results are reviewed by a molecular pathologist, incorporated into the pathology report, and communicated to the ordering clinician to guide tumor classification, prognosis, and therapeutic planning. Typical site of service is a clinical molecular pathology or reference diagnostic laboratory; specimen collection occurs in outpatient clinic, hospital inpatient, ambulatory surgical center, or procedural settings.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the professional interpretation/reporting portion is submitted separate from the lab's technical component. |