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CPT 81540: Molecular Tumor Profiling by RT-PCR and Algorithmic Analysis
CPT code 81540 designates a molecular diagnostic service that combines technical RT–PCR testing of 92 genes on tumor tissue with an algorithmic analysis to predict a tumor’s main cancer type and subtype. This code captures both the laboratory analytic component and the computational interpretation that yields a probabilistic cancer-type report, making it relevant for precision oncology workups and cases where tissue-based molecular classification informs diagnostic clarity.
Key national payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what CPT code 81540 represents, why it matters for laboratory and oncology providers, and the typical clinical and laboratory contexts in which it is used.
The publication summarizes expected benchmarks and adoption considerations, clarifies clinical context for ordering and reporting such tests, and highlights where policy updates and payer coverage practices can influence access to algorithm-driven tumor profiling. The content is intended as a national-level reference for health plan administrators, laboratory directors, and oncology practice managers seeking a clear description of the service and the key issues surrounding reimbursement and clinical utility.
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Billing Code Overview
CPT code 81540 describes a laboratory service in which a lab analyst performs technical real-time reverse transcription–polymerase chain reaction (RT–PCR) testing for 92 genes on tumor tissue and then applies an algorithmic analysis combining the assay results with patient data to report a probability of predicted main cancer type and subtype.
Service type: Molecular diagnostic tumor profiling with algorithmic interpretation.
Typical site of service: Clinical molecular laboratory or reference laboratory using tumor tissue specimens.
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