Summary & Overview
CPT 81419: Genomic Sequence Analysis Panel for Solid Organ Neoplasms
CPT code 81419 represents a genomic sequence analysis panel for solid organ neoplasms, focusing on DNA analysis of 5 to 50 genes. This advanced laboratory service is pivotal in cancer diagnostics, offering detailed genetic insights that inform treatment strategies and support precision medicine. The code is widely recognized across major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, reflecting its importance in clinical and reimbursement settings.
This publication provides a comprehensive overview of 81419, covering payer coverage, clinical context, and relevant policy updates. Readers will gain insight into benchmarks for utilization, the role of independent laboratories, and the significance of this code in the evolving landscape of molecular pathology. The analysis also highlights associated modifiers, taxonomies, and related CPT codes, offering a clear understanding of how 81419 fits within broader oncology testing protocols. The summary is designed for healthcare professionals, administrators, and policy stakeholders seeking up-to-date information on genomic testing for solid organ cancers.
CPT Code Overview
CPT code 81419 is used for genomic sequence analysis panels targeting solid organ neoplasms. This procedure involves DNA analysis of 5 to 50 genes, providing critical information for the diagnosis and management of various cancers. The service falls under Pathology and Laboratory, with the typical site of service being an Independent Laboratory (Place of Service 81). This code enables comprehensive genetic profiling, supporting precision medicine approaches in oncology.
Clinical & Coding Specifications
Clinical Context
A patient diagnosed with a solid organ malignancy, such as lung, breast, colon, prostate, or pancreatic cancer, is referred for advanced molecular testing. The treating physician requests a genomic sequence analysis panel to identify DNA mutations across 5-50 genes relevant to the neoplasm. The specimen, typically a tissue biopsy from the affected organ, is sent to an independent laboratory (Place of Service 81) specializing in molecular pathology. The laboratory performs the analysis using CPT code 81419, generating a report that assists the oncology team in determining targeted therapies or prognostic information. The workflow involves specimen collection, laboratory processing, genomic sequencing, and interpretation by a pathologist or molecular genetic specialist.
Coding Specifications
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Modifiers:
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26: Used to indicate the professional component, when only the interpretation of the test is performed by the provider. - Modifier
59: Used to denote a distinct procedural service, when the procedure is separate from other services performed on the same day.
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Provider Taxonomies:
Code Specialty Name