CPT 81455: Targeted Genomic Panel, 51+ Genes for Oncology and Hematology
CPT code 81455 represents a comprehensive targeted genomic sequencing panel that evaluates 51 or more genes for DNA (and when applicable RNA) alterations in tumor tissue or bone marrow tied to solid organ malignancies and hematolymphoid disorders. Nationally, such multi-gene panels are central to precision oncology and hematology, informing diagnosis, prognosis, and potential targeted therapy selection across a broad patient population.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for use of large targeted panels, comparisons to related CPT codes for smaller and RNA-specific panels, and typical billing considerations. The publication also summarizes payer coverage patterns, common billing modifiers encountered in molecular pathology claims, and the service settings where this testing is most commonly performed.
This summary equips clinicians, laboratory managers, and revenue cycle staff with a concise reference to the clinical intent and billing context of CPT code 81455, clarifying where it fits relative to panels that test fewer genes and RNA-specific assays. Data not available in the input are noted where applicable.
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Billing Code Overview
CPT code 81455 describes a targeted genomic sequence analysis panel of 51 or more genes performed on a patient specimen such as tumor tissue or bone marrow. The analysis evaluates DNA and, when applicable, RNA alterations in genes known to be associated with solid organ cancers or hematolymphoid (blood and lymph) disorders or cancers.
Service Type: Targeted genomic sequencing / molecular diagnostic panel
Typical Site of Service: Clinical laboratory or pathology laboratory supporting oncology and hematology diagnostics
National Reimbursement Benchmarks
National commercial benchmarks for CPT 81455 center around BUCA’s average commercial rate of $2,808.90, with other major payers showing meaningful variation. Blue Cross Blue Shield’s median of $2,813.70 and Cigna’s median of $2,651.10 sit near BUCA’s mean, while Aetna’s median of $1,323.00 and UnitedHealth Group’s median of $1,751.80 are notably lower. Cigna and Blue Cross Blue Shield display higher upper-end ceilings (maxes of $8,820.10 and $17,974.30 respectively), which contributes to wider dispersion compared with BUCA’s central tendency.
Examining interquartile dispersion (P75 minus P25) highlights where rates are tightest and widest: UnitedHealth Group’s IQR is $1,693.40 ($2,919.60 − $1,226.20), Cigna’s IQR is $2,285.00 ($3,778.40 − $1,493.40), Blue Cross Blue Shield’s IQR is $1,070.20 ($3,317.20 − $2,247.00), and Aetna’s IQR is $1,725.00 ($2,394.00 − $719.00). Blue Cross Blue Shield shows the tightest IQR, while Cigna shows the widest interquartile spread, with BUCA positioned near the market average at a mean of $2,808.90.