CPT 81464: Plasma cfDNA Genomic Sequencing for Solid Tumors
Commercial payers pay $2689 on average nationally for this procedure.
CPT code 81464 describes a liquid biopsy genomic sequencing procedure performed on a plasma specimen to analyze cell-free DNA (cfDNA) and DNA/RNA for sequence variants, copy number variants, and rearrangements relevant to solid organ neoplasms; the test also assesses biomarkers such as microsatellite instability (MSI) and tumor mutation burden (TMB). Service type: genomic sequencing for somatic alterations; typical site of service: clinical laboratory/diagnostic laboratory or outpatient specimen collection.
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 reimbursement for CPT 81464 centers near the BUCA average commercial rate of $2,688.90, with notable differences across major carriers. Blue Cross Blue Shield shows the highest dispersion between its 25th and 75th percentiles ($1,717.70), indicating wide variability in negotiated rates; Cigna and Aetna have moderate spreads of $2,144.40 and $1,097.00 respectively. UnitedHealth Group’s interquartile spread is $1,907.30, also reflecting substantial variability, while BUCA’s IQR is $1,717.00 and thus aligns closely with Blue Cross Blue Shield in dispersion.
Looking at central tendency, Cigna’s median ($2,946.50) and Blue Cross Blue Shield’s median ($2,572.30) sit above the BUCA mean, while UnitedHealth Group’s median ($1,973.10) falls below. Minimum-to-maximum ranges exist for Aetna, Blue Cross Blue Shield, Cigna, and UnitedHealth Group per the provided values, underscoring that list extremes can differ markedly even when averages cluster near the BUCA commercial benchmark of $2,688.90.