Summary & Overview
CPT 81477: Molecular Pathology Procedure, Level 9 DNA Sequence Analysis
CPT code 81477 is a high-complexity molecular pathology procedure used for DNA sequence analysis of 11-25 exons within a single gene. This code is significant in the national landscape of laboratory medicine, as it enables precise genetic testing for a range of clinical indications, including cancer diagnostics, hereditary disease risk assessment, and targeted screening for genetic anomalies. The procedure is typically performed in specialized laboratory settings and is integral to advancing personalized medicine and improving patient outcomes.
The publication provides a comprehensive overview of 81477, including its clinical context, typical site of service, and associated billing practices. Key payer coverage is highlighted, with Blue Cross Blue Shield as a primary example. Readers will gain insights into relevant benchmarks, policy updates, and the role of this code in modern pathology and laboratory workflows. The summary also addresses common modifiers and related codes, offering clarity on how 81477 fits within broader molecular testing panels and reimbursement structures. This resource is designed for healthcare professionals, billing specialists, and policy analysts seeking up-to-date information on advanced molecular pathology procedures.
CPT Code Overview
CPT code 81477 represents a molecular pathology procedure, Level 9, which typically involves the analysis of 11-25 exons in a single gene by DNA sequence analysis. This code is used within the Pathology and Laboratory service type and is most commonly performed in a laboratory setting, designated as Place of Service 81. The procedure is essential for advanced genetic testing, supporting clinical decision-making in areas such as oncology, hereditary disease screening, and personalized medicine.
Clinical & Coding Specifications
Clinical Context
A patient presents to their physician with a personal or family history of cancer, such as breast cancer, or is undergoing screening for genetic and chromosomal anomalies. The physician orders a molecular pathology procedure to analyze 11-25 exons in a single gene by DNA sequence analysis, which is performed in a laboratory setting (Place of Service 81). The results help guide diagnosis, prognosis, or treatment decisions, particularly in cases of suspected or confirmed malignancy or genetic disease. The workflow involves specimen collection, laboratory analysis, and interpretation by a pathologist or clinical laboratory specialist.
Coding Specifications
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Modifiers:
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26: Used to indicate the professional component of the service, typically when the provider is only interpreting the results and not performing the technical laboratory work. - Modifier
59: Used to denote a distinct procedural service, indicating that the procedure is separate from other services performed on the same day.
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Provider Taxonomies:
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