Summary & Overview
CPT 81352: Targeted TP53 Gene Sequencing for Li–Fraumeni Syndrome
CPT code 81352 represents targeted molecular sequencing of the TP53 gene, a diagnostic laboratory test used to identify pathogenic variants associated with Li–Fraumeni syndrome. This test has national clinical importance because identification of TP53 mutations can affect cancer surveillance, treatment decisions, and trigger family cascade testing. Payers commonly covering molecular genetic testing in analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of the clinical context for TP53 targeted sequencing, including the typical laboratory setting and specimen types. The publication summarizes coverage and reimbursement considerations across major payers, common billing modifiers, and practical coding notes relevant to laboratory service lines. It also highlights policy and benchmark topics that affect access to hereditary cancer testing, such as medical necessity criteria, preauthorization trends, and coverage policy language. The piece is intended for billing managers, laboratory directors, and policy analysts seeking a national-level briefing on the use and administrative handling of CPT code 81352.
Billing Code Overview
CPT code 81352 describes a laboratory molecular test that analyzes targeted gene sequences of the tumor protein 53 (TP53) gene. The service involves a laboratory analyst performing the technical testing on a clinical specimen, such as blood, to detect TP53 variants that can indicate Li–Fraumeni syndrome and inform cascade testing of family members.
-
Service type: Molecular genetic testing (targeted sequencing of the TP53 gene)
-
Typical site of service: Clinical laboratory or reference molecular diagnostics laboratory where blood or other patient specimens are processed and analyzed.
Data not available in the input for payers, associated taxonomies, ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A 34-year-old female with a strong personal and family history of early-onset cancers (breast cancer at age 29 and a father with sarcoma) is referred to a medical genetics clinic for hereditary cancer evaluation. The clinician orders targeted sequencing of the TP53 gene to evaluate for pathogenic variants consistent with Li–Fraumeni syndrome. A phlebotomy draw is performed in an outpatient laboratory; the specimen is sent to a molecular diagnostics lab where a laboratory analyst performs the technical testing of the specimen to sequence and analyze targeted TP53 gene regions. Results are reported to the ordering clinician; if a pathogenic or likely pathogenic variant is identified, cascade testing of at-risk family members is often recommended by the genetics team. Typical workflow steps: clinic genetics consult and consent, specimen collection (blood), sample accessioning and extraction in the molecular lab, targeted TP53 sequencing/analysis, technical interpretation and reporting, and delivery of results to the ordering provider for clinical management decisions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing separate professional interpretation/reporting by a pathologist or molecular geneticist distinct from the technical lab work |
TC |