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CPT 81463: Liquid Biopsy cfDNA Genomic Panel for Solid Tumors
CPT code 81463 represents a plasma/serum-based liquid biopsy genomic sequencing panel that analyzes cell-free DNA (cfDNA) to detect sequence variants, copy number changes, and microsatellite instability (MSI) in solid organ tumors. This testing modality supports noninvasive tumor profiling for diagnostic refinement, therapy selection, and monitoring when tissue biopsy is limited or not feasible. Nationally, cfDNA panels are increasingly used across oncology care pathways and affect molecular testing workflows, payer coverage decisions, and precision oncology access.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes payer coverage patterns, coding and billing considerations, and how CPT code 81463 aligns with related molecular and pathology services.
Readers will learn: an overview of the clinical scope and laboratory setting for CPT code 81463; how this code relates to other molecular and anatomic pathology services; common billing modifiers and practical coding linkages; and typical diagnostic indications tied to solid tumor malignancies. The report also presents benchmarking context and policy implications relevant to national payers and laboratory providers. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 81463 describes a liquid biopsy genomic sequence analysis performed on a serum specimen to detect cell-free DNA (cfDNA) alterations relevant to solid organ tumors. The assay evaluates nucleic acid sequence variants, copy number variants, and microsatellite instability (MSI) to inform tumor characterization and potential treatment implications.
Service Type: Genomic sequencing (cfDNA) for solid tumor profiling
Typical Site of Service: Clinical laboratory or reference molecular diagnostics laboratory; specimen collected in an outpatient or ambulatory setting and processed in a laboratory
National Reimbursement Benchmarks
National commercial rates for CPT 81463 cluster around BUCA’s average commercial benchmark of $1,192.40, with notable variation by carrier. Blue Cross Blue Shield (BCBS) and Cigna show higher central tendencies (medians $1,150.30 and $1,545.90 respectively), while Aetna and UnitedHealth Group sit lower on median. Cigna and BCBS present high ceilings (max $4,346.50 and $2,789.20) that pull their means up above BUCA’s average, indicating some outlier high contracts among commercial payers.
Examining dispersion (P75 minus P25) highlights where rates are most and least concentrated: Blue Cross Blue Shield has the widest interquartile spread at $575.80 ($1,524.70 - $934.90), followed by Cigna at $1,268.20 ($1,963.20 - $695.50) and BUCA at $597.60 ($1,497.60 - $790.20). UnitedHealth Group is the tightest at $679.30 ($1,345.30 - $565.00), with Aetna’s spread at $427.10 ($1,103.20 - $676.10), indicating relatively more compressed commercial contracting for Aetna and UnitedHealth Group compared with BCBS and Cigna.