Summary & Overview
CPT 81404: Molecular Genetic Testing for MEN1 and TP53
CPT code 81404 represents a Tier 2 molecular pathology procedure focused on genetic testing for MEN1 and targeted sequence analysis of 2–5 exons of TP53. This code is significant in the national landscape of precision medicine, as it enables clinicians to detect genetic mutations linked to multiple endocrine neoplasia and various forms of leukemia and cancer. The procedure is typically performed in clinical laboratory settings and is essential for informing diagnosis and treatment strategies in oncology and endocrinology.
Major national payers covering this code include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. The publication provides an overview of payer coverage, clinical context, and relevant policy updates. Readers will gain insights into coding benchmarks, laboratory billing practices, and the role of molecular genetic testing in patient care. The summary also highlights associated ICD-10 diagnoses, common modifiers, and related CPT codes, offering a comprehensive view of how CPT 81404 fits into broader laboratory and pathology workflows. This information is valuable for understanding reimbursement trends, compliance requirements, and the evolving landscape of genetic testing in clinical practice.
CPT Code Overview
CPT 81404 is used for molecular pathology procedures, specifically for duplication and deletion analysis of MEN1 (multiple endocrine neoplasia 1) and targeted sequence analysis of 2–5 exons of TP53 (tumor protein 53). This code is commonly billed for genetic testing services that help identify mutations associated with certain endocrine and oncologic conditions. The typical site of service for CPT 81404 is a clinical laboratory, with billing most often occurring under laboratory settings such as place of service codes 19 or 81. These tests play a critical role in guiding diagnosis and management for patients with suspected genetic abnormalities related to MEN1 and TP53.
Clinical & Coding Specifications
Clinical Context
A patient with a suspected or confirmed diagnosis of acute leukemia or myelodysplastic syndrome presents to a hematologist or oncologist. The provider orders molecular genetic testing to evaluate for mutations in the MEN1 gene (associated with multiple endocrine neoplasia type 1) and targeted sequence analysis of 2-5 exons of the TP53 gene (tumor protein 53), which are relevant for prognosis and treatment planning. The specimen is sent to a clinical laboratory (typically place of service 19 or 81) specializing in molecular pathology. The laboratory performs the duplication and deletion analysis for MEN1 and targeted sequencing for TP53, and reports the results back to the ordering provider for clinical interpretation and management.
Coding Specifications
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Modifiers:
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26: Used to indicate the professional component of the laboratory service, typically when the physician interprets the results but does not perform the technical portion. - Modifier
91: Used when the same clinical diagnostic laboratory test is repeated on the same patient on the same day to obtain additional information.
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Provider Taxonomies:
Taxonomy Code