Summary & Overview
CPT 81473: Targeted Genomic Sequence Analysis Panel for Solid Organ Neoplasms
CPT code 81473 represents a targeted genomic sequence analysis panel for solid organ neoplasms, involving DNA analysis of 5 to 50 genes. This advanced laboratory procedure is pivotal in oncology, offering precise genetic insights that inform diagnosis, prognosis, and treatment planning for patients with cancers such as lung, breast, colon, prostate, and pancreatic neoplasms. The code is primarily utilized in independent laboratory settings, reflecting the growing role of molecular diagnostics in cancer care.
Blue Cross Blue Shield is a key payer covered in this analysis, highlighting the importance of understanding payer policies and coverage for molecular pathology services. Readers will gain insights into national benchmarks, policy updates, and the clinical context surrounding the use of 81473. The publication also addresses relevant modifiers, associated taxonomies, and related CPT codes, providing a comprehensive overview for stakeholders in pathology, laboratory medicine, and family medicine.
This summary equips healthcare professionals, administrators, and policy analysts with essential information on the utilization, coverage, and clinical significance of targeted genomic sequencing in solid organ neoplasms, supporting informed decision-making in the evolving landscape of precision medicine.
CPT Code Overview
CPT code 81473 is used for targeted genomic sequence analysis panels focused on solid organ neoplasms. This procedure involves DNA analysis of 5 to 50 genes, providing critical information for the diagnosis and management of various cancers. The service is classified under Pathology and Laboratory, and is typically performed in an Independent Laboratory setting (Place of Service 81). This code enables clinicians to obtain detailed genetic profiles of tumors, supporting personalized treatment strategies and improving patient outcomes.
Clinical & Coding Specifications
Clinical Context
A patient diagnosed with a solid organ malignancy, such as lung, breast, colon, prostate, or pancreatic cancer, is referred for advanced molecular testing. The treating oncologist requests a targeted genomic sequence analysis panel to identify mutations in 5-50 genes relevant to the neoplasm. The specimen, typically a tissue biopsy from the affected organ, is sent to an independent laboratory (Place of Service 81). A pathologist specializing in molecular genetic pathology oversees the DNA analysis, which informs prognosis and potential targeted therapies. Results are integrated into the patient's oncology care plan.
Coding Specifications
-
Modifiers:
- Modifier
26: Used when reporting only the professional component of the laboratory service, such as interpretation of results by a pathologist. - Modifier
59: Indicates a distinct procedural service, used when the genomic panel is performed separately from other procedures.
- Modifier
-
Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207ZP0102X |