Summary & Overview
CPT 81433: Molecular Diagnostic Testing in Pathology and Laboratory Medicine
CPT code 81433, previously used for molecular diagnostic testing in pathology and laboratory medicine, has been deleted effective January 1, 2025. This change affects laboratories nationwide that relied on this code for genetic analysis related to oncology and other clinical indications. The publication provides an overview of the code's clinical context, its typical use in laboratory settings, and the implications of its deletion for billing and reimbursement practices. Key payers covered include Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, reflecting broad national coverage and relevance. Readers will gain insight into the code's historical application, associated diagnoses such as malignant neoplasms of the pancreas and breast, and related coding considerations. The summary also highlights important policy updates and benchmarks for pathology and laboratory services, equipping stakeholders with essential information for navigating upcoming changes in medical billing and coding.
CPT Code Overview
CPT 81433 was designated for pathology and laboratory services, specifically performed in a laboratory setting (POS 81). This code represented a molecular diagnostic procedure used to analyze genetic material, supporting clinical decision-making in oncology and other specialties. Effective January 1, 2025, CPT 81433 has been deleted from the CPT code set, impacting laboratories and providers who previously utilized this code for molecular testing.
Clinical & Coding Specifications
Clinical Context
A patient presents with a suspected or confirmed diagnosis of a malignant neoplasm involving the pancreas, peritoneum, or breast. The treating physician orders advanced molecular genetic testing to identify specific genetic mutations or alterations relevant to the cancer type. The laboratory receives the specimen and performs the analysis corresponding to CPT code 81433. Results are interpreted by a pathologist specializing in molecular genetic pathology. The findings assist in guiding treatment decisions, such as targeted therapies or eligibility for clinical trials. The service is typically performed in a laboratory setting (Place of Service 81), and the workflow involves specimen collection, laboratory processing, and professional interpretation.
Coding Specifications
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Modifiers:
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26: Used when reporting only the professional component (interpretation of results) of the laboratory service. - Modifier
TC: Used when reporting only the technical component (performance of the test) of the laboratory service. - Modifier
59: Used to indicate a distinct procedural service, typically when multiple procedures are performed and need to be reported separately.
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Provider Taxonomies: