Summary & Overview
CPT 81525: Colon Tumor 12-Gene RT–PCR Recurrence Score
CPT code 81525 designates a laboratory molecular diagnostic service that uses real-time RT–PCR on 12 genes from colon tumor tissue and an algorithmic analysis to report a patient recurrence score. This code matters nationally because it supports precision oncology decision-making by providing individualized prognostic information that can influence post-surgical treatment planning and surveillance strategies. Molecular diagnostics like this also drive reimbursement, coverage policy, and laboratory workflow considerations across payers.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage and reimbursement policy for algorithm-based molecular assays vary by payer and influence adoption, access, and coding practices.
Readers will find a concise overview of the clinical purpose and laboratory setting for the service, payer coverage context, and the types of benchmarks and policy updates commonly associated with genomic and algorithmic diagnostic codes. The publication also summarizes typical billing considerations, common modifiers in use, and where to find further coding and policy guidance. Data not available in the input for pay-by-pay benchmarks and associated taxonomies is noted where applicable.
Billing Code Overview
CPT code 81525 describes a laboratory service in which a lab analyst performs real-time reverse transcription polymerase chain reaction (RT–PCR) testing across 12 genes using colon tumor tissue and applies an algorithmic analysis combining patient data with test results to generate a patient recurrence score. This service is a molecular diagnostic assay that produces an individualized prognostic metric for colon cancer recurrence risk.
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Service type: Molecular diagnostic testing with algorithmic result reporting
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Typical site of service: Clinical molecular laboratory or pathology laboratory that processes tumor tissue samples
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Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with recently resected stage II–III colon adenocarcinoma has formalin-fixed paraffin-embedded (FFPE) tumor tissue submitted to a molecular pathology laboratory. The laboratory analyst receives the tissue block or unstained slides, extracts RNA, and performs real-time reverse transcription polymerase chain reaction (RT–PCR) targeting a 12-gene panel validated for colon cancer recurrence risk. The analyst runs technical assays, performs quality control, and uses an algorithm integrating the assay results with relevant clinical data (for example, tumor stage and sample quality) to generate a patient-specific recurrence score. The laboratory issues a report to the ordering oncologist and the surgical team to inform adjuvant therapy decision-making. Typical site of service is an independent clinical molecular laboratory or hospital-based molecular pathology lab; specimen collection and surgery occur in an ambulatory surgical center or hospital inpatient/outpatient surgical setting.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
TC | Technical component | Use when billing only the laboratory technical component of the test |
26 | Professional component |