Summary & Overview
CPT 81458: Genomic Sequence Analysis Panel for Solid Organ Neoplasms
CPT code 81458 represents a genomic sequence analysis panel for solid organ neoplasms, focusing on DNA sequence variants, copy number variants, and microsatellite instability. This advanced molecular assay is pivotal in oncology, enabling detailed tumor profiling that supports personalized cancer treatment strategies. The code is widely recognized and utilized in laboratory settings, reflecting the growing importance of precision medicine in cancer care.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, provide coverage for this procedure, underscoring its clinical relevance and adoption across the healthcare landscape. Readers will gain insights into payer coverage, clinical indications, and the role of 81458 in modern oncology diagnostics. The publication also addresses related policy updates, benchmarks, and the broader context of genomic sequencing procedures in cancer management.
This summary offers a comprehensive overview of the clinical and billing landscape for CPT code 81458, equipping stakeholders with essential information on payer policies, laboratory practices, and the evolving standards in molecular pathology for solid tumors.
CPT Code Overview
CPT code 81458 is used for genomic sequence analysis panels targeting solid organ neoplasms. This procedure involves interrogation for sequence variants, including DNA analysis, copy number variants, and microsatellite instability. It is classified under Genomic Sequencing Procedures and Other Molecular Multianalyte Assays, specifically for oncology solid tumor panels. The typical site of service for this test is a laboratory setting (POS 81). This code is integral for comprehensive molecular profiling of solid tumors, supporting precision oncology and informing treatment decisions.
Clinical & Coding Specifications
Clinical Context
A patient with a suspected or confirmed malignant neoplasm of the gastrointestinal tract, such as the duodenum, small intestine, colon, rectum, or anal canal, is referred for advanced genomic testing. The ordering physician, often a specialist in oncology, pathology, or medical genetics, requests a solid organ neoplasm genomic sequence analysis panel to interrogate for sequence variants, copy number variants, and microsatellite instability. The specimen is sent to a laboratory (Place of Service 81), where the test is performed. Results are interpreted by a qualified provider, such as a medical geneticist or molecular pathologist, to inform diagnosis, prognosis, or targeted therapy options.
Coding Specifications
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Modifiers:
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26: Used when reporting only the professional component (interpretation of results) of the procedure. - Modifier
TC: Used when reporting only the technical component (performance of the test in the laboratory).
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Provider Taxonomies:
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