CPT 81519: 21-Gene Breast Cancer Recurrence Score

CPT code 81519 describes a laboratory service that performs quantitative molecular testing of a 21-gene panel and applies an algorithmic analysis of patient clinical data and assay results to generate a breast cancer recurrence score used to inform prognosis and treatment planning; the service is a molecular diagnostic assay with algorithmic (proprietary) analysis typically performed in a clinical molecular pathology or specialized diagnostic laboratory (technical lab testing and computational analysis).

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CPT 81519: 21-Gene Breast Cancer Recurrence Score

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Get alerted when payer policies referencing 81519 are released or updated.

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Clinical & Coding Specifications

Clinical Context

A 55-year-old woman with newly diagnosed, early-stage, estrogen receptor–positive, HER2-negative invasive breast carcinoma undergoes lumpectomy with sentinel lymph node biopsy. Final pathology shows a 1.8 cm invasive ductal carcinoma, node-negative, and the multidisciplinary team requests genomic risk stratification to inform adjuvant chemotherapy decisions. A pathology specimen (formalin-fixed, paraffin-embedded tumor tissue) is sent to a certified molecular diagnostics laboratory. The lab analyst performs the technical assay measuring expression of 21 genes and integrates patient clinical data (tumor size, node status, ER/PR/HER2 results) with the assay results through a validated algorithm to generate a numerical recurrence score.

The clinical workflow: the clinician orders the test and attaches required clinical data and diagnosis codes. The specimen is shipped to the reference lab, accessioned, and QC performed. The technologist runs the assay, and the laboratory analyst performs the algorithmic analysis to calculate the recurrence score. Results are reported to the ordering physician and incorporated into the oncology treatment planning visit to guide adjuvant chemotherapy recommendations.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`81519`	Oncology (breast) multigene expression assay, algorithmic analysis and report (recurrence score) for 21 genes	Primary assay code describing the laboratory's algorithmic analysis and report of a 21-gene recurrence score used to guide adjuvant therapy decisions.
`88305`	Level IV surgical pathology, gross and microscopic examination	Performed by pathology to evaluate the surgical specimen; provides tissue diagnosis and selects tissue for molecular testing prior to sending to the reference lab.
`88342`	Immunohistochemistry (per single stain)	Used to report ER, PR, and HER2 immunohistochemical testing that complements the genomic assay and is part of treatment planning.
`88172`	Cytopathology, fine needle aspiration (microscopic)	If FNA is used for diagnosis or molecular testing specimen procurement; less common for this assay but part of specimen collection workflow.
`99000`	Handling and/or conveyance of specimen to a distant site (historical; use payer-specific codes)	Represents specimen handling/shipping activities to an external reference laboratory when payer requires a handling code (apply per payer guidelines).

Related Modifiers

5 rows

Modifier	Description	When to Use
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
90	Modifier ‑90 (Reference/Outside Laboratory) indicates that a laboratory test was performed by an entity other than the treating or reporting provider. The American Medical Association defines…	- Use CPT modifier -90 when a laboratory test is performed by an outside/reference laboratory (an entity other than the treating or reporting physician or qualified professional) and the claim needs…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
363L00000X	Nurse Practitioner	(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
207RC0000X	Cardiovascular Disease Physician	An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threaten…
2084P0800X	Psychiatry Physician	A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
207ZC0006X	Clinical Pathology Physician	A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the labora…
2084S0010X	Sports Medicine (Psychiatry & Neurology) Physician	A psychiatrist or neurologist who specializes in the diagnosis and treatment of sports related conditions and injuries.
2080P0207X	Pediatric Hematology & Oncology Physician	A pediatrician trained in the combination of pediatrics, hematology and oncology to recognize and manage pediatric blood disorders and cancerous disea…
376G00000X	Nursing Home Administrator	An individual, often licensed by the state, who is responsible for the management of a nursing home.

Related ICD-10-CM Codes

27 rows

ICD-10-CM Code	Description
C50.012	Malignant neoplasm of nipple and areola, left female breast
C50.111	Malignant neoplasm of central portion of right female breast
C50.112	Malignant neoplasm of central portion of left female breast
C50.121	Malignant neoplasm of central portion of right male breast
C50.122	Malignant neoplasm of central portion of left male breast
C50.212	Malignant neoplasm of upper-inner quadrant of left female breast
C50.311	Malignant neoplasm of lower-inner quadrant of right female breast
C50.312	Malignant neoplasm of lower-inner quadrant of left female breast
C50.411	Malignant neoplasm of upper-outer quadrant of right female breast
C50.412	Malignant neoplasm of upper-outer quadrant of left female breast

Showing 1–10 of 27

Related Payer Policy Updates

Specialty: Genetic & Molecular Testing1 / 3

10 rows

Policy	Payer	Effective Date
RTM Testing of Homocysteine Metabolism-Related Conditions	Oscar Health	2026-10-01
Multimarker Serum Testing Related to Ovarian Cancer	Blue Cross Blue Shield - Rhode Island	2026-09-01
Genomic Profiling for Selecting Targeted Cancer Therapies	Blue Cross Blue Shield - Rhode Island	2026-09-01
Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders	Blue Cross Blue Shield - Rhode Island	2026-09-01
Biomarker and Genetic/Molecular Testing Coverage and Prior Authorization	Blue Cross Blue Shield - Rhode Island	2026-09-01
Non-Invasive Prenatal Testing (NIPT)	univerahealthcare	2026-08-17
Lumizyme (alglucosidase alfa) — Pompe Disease (acid alpha‑glucosidase deficiency)	Cigna	2026-08-15
Molecular Oncology Testing for Solid Tumor Cancer Diagnosis, Prognosis, and Treatment Decisions	Colorado Rocky Mountain Health Plans	2026-08-01
Molecular Oncology Testing for Hematologic Cancer Diagnosis, Prognosis, and Treatment Decisions	Colorado Rocky Mountain Health Plans	2026-08-01
Carrier Testing Panels for Genetic Diseases	Colorado Rocky Mountain Health Plans	2026-08-01

CPT 81490: Serum Biomarker Panel and RA Disease Activity Score

CPT-81493-CORONARY-ARTERY-DISEASE-23-GENE-RT-PCR-RISK-SCORE

CPT 81493: 23-Gene RT-PCR Molecular Test With CAD Risk Score

CPT-81500-CA125-HE4-ALGORITHMIC-RISK-SCORE

CPT 81500: Algorithmic Risk Score Using CA-125 and HE4

CPT-81503-ALGORITHMIC-LAB-RISK-SCORE-CA125-APOLIPOPROTEIN-A1

CPT 81503: Algorithmic Risk Score from Multiple Lab Markers

CPT-81504-TUMOR-ORIGIN-RNA-EXPRESSION-CLASSIFIER

CPT 81504: Tumor RNA Expression Profile Comparison

CPT-81506-DIABETES-BIOMARKER-PANEL-WITH-RISK-SCORE

CPT 81506: Diabetes Risk Score from Biochemical Assays

CPT-81507-NIPS-CELL-FREE-DNA-TRISOMY-RISK-ANALYSIS

CPT 81507: Noninvasive Prenatal Testing for Trisomies 13, 18, 21

CPT-81508-PAPP-A-HCG-ALGORITHMIC-RISK-ASSAY

CPT 81508: First-Trimester PAPP-A and hCG Risk Score

CPT-81509-LAB-ALGORITHMIC-RISK-ASSESSMENT-PAPP-A-HCG-DIA

CPT 81509: Prenatal Biochemical Risk Score from PAPP–A, hCG, DIA

CPT-81510-PRENATAL-TRIPLE-MARKER-ALGORITHMIC-RISK-ASSESSMENT

CPT 81510: Prenatal Serum Screening with Algorithmic Risk Score

Showing 1–10 of 41

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`81519`	Oncology (breast) multigene expression assay, algorithmic analysis and report (recurrence score) for 21 genes	Primary assay code describing the laboratory's algorithmic analysis and report of a 21-gene recurrence score used to guide adjuvant therapy decisions.
`88305`	Level IV surgical pathology, gross and microscopic examination	Performed by pathology to evaluate the surgical specimen; provides tissue diagnosis and selects tissue for molecular testing prior to sending to the reference lab.
`88342`	Immunohistochemistry (per single stain)	Used to report ER, PR, and HER2 immunohistochemical testing that complements the genomic assay and is part of treatment planning.
`88172`	Cytopathology, fine needle aspiration (microscopic)	If FNA is used for diagnosis or molecular testing specimen procurement; less common for this assay but part of specimen collection workflow.
`99000`	Handling and/or conveyance of specimen to a distant site (historical; use payer-specific codes)	Represents specimen handling/shipping activities to an external reference laboratory when payer requires a handling code (apply per payer guidelines).

Related Modifiers

5 rows

Modifier	Description	When to Use
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
90	Modifier ‑90 (Reference/Outside Laboratory) indicates that a laboratory test was performed by an entity other than the treating or reporting provider. The American Medical Association defines…	- Use CPT modifier -90 when a laboratory test is performed by an outside/reference laboratory (an entity other than the treating or reporting physician or qualified professional) and the claim needs…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
363L00000X	Nurse Practitioner	(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
207RC0000X	Cardiovascular Disease Physician	An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threaten…
2084P0800X	Psychiatry Physician	A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
207ZC0006X	Clinical Pathology Physician	A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the labora…
2084S0010X	Sports Medicine (Psychiatry & Neurology) Physician	A psychiatrist or neurologist who specializes in the diagnosis and treatment of sports related conditions and injuries.
2080P0207X	Pediatric Hematology & Oncology Physician	A pediatrician trained in the combination of pediatrics, hematology and oncology to recognize and manage pediatric blood disorders and cancerous disea…
376G00000X	Nursing Home Administrator	An individual, often licensed by the state, who is responsible for the management of a nursing home.

Related ICD-10-CM Codes

27 rows

ICD-10-CM Code	Description
C50.012	Malignant neoplasm of nipple and areola, left female breast
C50.111	Malignant neoplasm of central portion of right female breast
C50.112	Malignant neoplasm of central portion of left female breast
C50.121	Malignant neoplasm of central portion of right male breast
C50.122	Malignant neoplasm of central portion of left male breast
C50.212	Malignant neoplasm of upper-inner quadrant of left female breast
C50.311	Malignant neoplasm of lower-inner quadrant of right female breast
C50.312	Malignant neoplasm of lower-inner quadrant of left female breast
C50.411	Malignant neoplasm of upper-outer quadrant of right female breast
C50.412	Malignant neoplasm of upper-outer quadrant of left female breast

Showing 1–10 of 27

Related Payer Policy Updates

Specialty: Genetic & Molecular Testing1 / 3

10 rows

Policy	Payer	Effective Date
RTM Testing of Homocysteine Metabolism-Related Conditions	Oscar Health	2026-10-01
Multimarker Serum Testing Related to Ovarian Cancer	Blue Cross Blue Shield - Rhode Island	2026-09-01
Genomic Profiling for Selecting Targeted Cancer Therapies	Blue Cross Blue Shield - Rhode Island	2026-09-01
Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders	Blue Cross Blue Shield - Rhode Island	2026-09-01
Biomarker and Genetic/Molecular Testing Coverage and Prior Authorization	Blue Cross Blue Shield - Rhode Island	2026-09-01
Non-Invasive Prenatal Testing (NIPT)	univerahealthcare	2026-08-17
Lumizyme (alglucosidase alfa) — Pompe Disease (acid alpha‑glucosidase deficiency)	Cigna	2026-08-15
Molecular Oncology Testing for Solid Tumor Cancer Diagnosis, Prognosis, and Treatment Decisions	Colorado Rocky Mountain Health Plans	2026-08-01
Molecular Oncology Testing for Hematologic Cancer Diagnosis, Prognosis, and Treatment Decisions	Colorado Rocky Mountain Health Plans	2026-08-01
Carrier Testing Panels for Genetic Diseases	Colorado Rocky Mountain Health Plans	2026-08-01

CPT 81490: Serum Biomarker Panel and RA Disease Activity Score

CPT-81493-CORONARY-ARTERY-DISEASE-23-GENE-RT-PCR-RISK-SCORE

CPT 81493: 23-Gene RT-PCR Molecular Test With CAD Risk Score

CPT-81500-CA125-HE4-ALGORITHMIC-RISK-SCORE

CPT 81500: Algorithmic Risk Score Using CA-125 and HE4

CPT-81503-ALGORITHMIC-LAB-RISK-SCORE-CA125-APOLIPOPROTEIN-A1

CPT 81503: Algorithmic Risk Score from Multiple Lab Markers

CPT-81504-TUMOR-ORIGIN-RNA-EXPRESSION-CLASSIFIER

CPT 81504: Tumor RNA Expression Profile Comparison

CPT-81506-DIABETES-BIOMARKER-PANEL-WITH-RISK-SCORE

CPT 81506: Diabetes Risk Score from Biochemical Assays

CPT-81507-NIPS-CELL-FREE-DNA-TRISOMY-RISK-ANALYSIS

CPT 81507: Noninvasive Prenatal Testing for Trisomies 13, 18, 21

CPT-81508-PAPP-A-HCG-ALGORITHMIC-RISK-ASSAY

CPT 81508: First-Trimester PAPP-A and hCG Risk Score

CPT-81509-LAB-ALGORITHMIC-RISK-ASSESSMENT-PAPP-A-HCG-DIA

CPT 81509: Prenatal Biochemical Risk Score from PAPP–A, hCG, DIA

CPT-81510-PRENATAL-TRIPLE-MARKER-ALGORITHMIC-RISK-ASSESSMENT

CPT 81510: Prenatal Serum Screening with Algorithmic Risk Score

Showing 1–10 of 41

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 81519: 21-Gene Breast Cancer Recurrence Score

Sign up for cpt 81519 policy alerts

OpenPayer

CPT 81519: 21-Gene Breast Cancer Recurrence Score

Sign up for cpt 81519 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

References

CPT 81519: 21-Gene Breast Cancer Recurrence Score

Sign up for cpt 81519 policy alerts

CPT 81519: 21-Gene Breast Cancer Recurrence Score

Sign up for cpt 81519 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

What does CPT 81519 represent?

Are pathology and IHC services billed separately from the 21-gene assay?

In what clinical scenario is the 21-gene recurrence score typically ordered and reported?

Which diagnosis codes are commonly associated with ordering this assay?

How is specimen shipping/handling to the reference laboratory addressed in coding?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

What does CPT 81519 represent?

Are pathology and IHC services billed separately from the 21-gene assay?

In what clinical scenario is the 21-gene recurrence score typically ordered and reported?

Which diagnosis codes are commonly associated with ordering this assay?

How is specimen shipping/handling to the reference laboratory addressed in coding?

References