Summary & Overview
CPT 81405: TP53 Full Gene Sequence or Targeted Analysis (>5 Exons)
CPT code 81405 represents advanced genetic testing for the TP53 gene, a crucial marker in hereditary cancer syndromes and tumor analysis. This code covers full gene sequencing or targeted analysis of more than five exons, providing essential information for clinicians managing patients with suspected or confirmed genetic predispositions to cancer, such as Li-Fraumeni syndrome. The procedure is classified under genetic/molecular pathology and is typically performed in laboratory or hospital settings.
Major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare recognize and reimburse for this service, reflecting its clinical importance and widespread adoption. Readers will gain insight into payer coverage, clinical indications, and the procedural context for TP53 testing. The publication also addresses relevant benchmarks, policy updates, and the evolving role of genetic testing in oncology and hematology. Understanding the scope and application of CPT 81405 is vital for stakeholders navigating the intersection of clinical practice, laboratory medicine, and payer policy.
CPT Code Overview
CPT 81405 is used to report genetic and molecular pathology testing for the full gene sequence or targeted sequence analysis of more than five exons of the TP53 (tumor protein 53) gene. This testing is clinically relevant for conditions such as Li-Fraumeni syndrome and various tumor samples, providing critical information for diagnosis and management of hereditary cancer syndromes and certain hematologic malignancies. The service is typically performed in a laboratory setting (POS 81) or within a hospital (POS 19), depending on the clinical context. As a molecular pathology procedure, it plays a key role in precision medicine and cancer risk assessment.
Clinical & Coding Specifications
Clinical Context
A patient presents with a suspected or confirmed hematologic malignancy, such as acute myelogenous leukemia or myelodysplastic syndrome. The treating physician, often a hematologist or oncologist, orders genetic testing to assess for mutations in the TP53 gene, which may influence prognosis and treatment decisions. The laboratory receives a tumor or blood sample and performs full gene sequencing or targeted analysis of more than 5 exons of TP53, as described by CPT code 81405. Results are interpreted by a pathologist or clinical laboratory specialist and reported back to the ordering provider for integration into the patient's care plan.
Coding Specifications
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Modifier
26: Used to indicate the professional component of the laboratory service, typically when the interpretation is performed separately from the technical component. -
Modifier
91: Used when the laboratory test is repeated on the same patient for clinical reasons, such as monitoring disease progression or response to therapy.
| Modifier Code | Description |
|---|---|
26 | Professional Component |