Summary & Overview
CPT 81453: Targeted Genomic Sequence Analysis Panel for Solid Organ Neoplasms
CPT code 81453 represents targeted genomic sequence analysis panels for solid organ neoplasms, analyzing DNA from 5 to 50 genes. This advanced laboratory procedure is increasingly important in oncology, as it supports precision medicine by identifying genetic mutations relevant to cancer diagnosis and treatment. The code is primarily utilized in independent laboratory settings, reflecting the growing role of molecular diagnostics in cancer care.
Blue Cross Blue Shield is a key payer covering this service, highlighting its national relevance and widespread adoption. Readers will gain insights into clinical benchmarks, policy updates, and the broader context of genomic testing in oncology. The publication also explores related codes, common modifiers, and associated taxonomies, providing a comprehensive overview of billing and clinical considerations for 81453. Understanding this code is essential for stakeholders navigating the evolving landscape of molecular pathology and laboratory medicine.
CPT Code Overview
CPT code 81453 is used for targeted genomic sequence analysis panels focused on 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 and is typically performed in an Independent Laboratory setting (Place of Service 81). This code enables clinicians to obtain detailed genetic profiles of tumors, supporting personalized treatment strategies and improving patient outcomes.
Clinical & Coding Specifications
Clinical Context
A patient diagnosed with a solid organ neoplasm, such as lung, breast, colon, prostate, or pancreatic cancer, is referred for advanced molecular testing. The treating oncologist requests targeted genomic sequence analysis to identify mutations in 5-50 genes relevant to the tumor type. The specimen, typically a tissue biopsy, is sent to an independent laboratory (Place of Service 81) specializing in molecular pathology. The laboratory performs DNA analysis using a targeted panel to guide potential treatment options, such as targeted therapies or clinical trial eligibility. Results are interpreted by a pathologist with expertise in molecular genetic pathology and reported back to the clinical team for integration into the patient's care plan.
Coding Specifications
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Modifier
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.
| Modifier Code | Description |
|---|---|
26 |