CPT 81455: Targeted Genomic Sequence Panel, 51+ Genes
Commercial payers pay $2809 on average nationally for this procedure.
CPT code 81455 describes a targeted genomic sequence analysis panel performed by a laboratory analyst to evaluate a patient specimen (for example, tumor tissue or bone marrow) for DNA and optionally RNA alterations across 51 or more genes associated with solid organ neoplasms or hematolymphoid (blood/lymph) disorders; the service is a molecular diagnostic sequencing test typically provided by a clinical molecular pathology laboratory and usually performed on pathology/laboratory sites such as hospital laboratories, reference labs, or specialized molecular diagnostic centers.
For related coverage guidance, see recent payer policy updates: RTM Testing of Homocysteine Metabolism-Related Conditions, Multimarker Serum Testing Related to Ovarian Cancer, Genomic Profiling for Selecting Targeted Cancer Therapies.
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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.