CPT code 81551 covers a molecular diagnostic laboratory assay that assesses promoter methylation in three genes and uses an algorithm combining test results with patient data to produce a score estimating the likelihood of finding prostate cancer on repeat biopsy after an initial negative biopsy. This test matters nationally as precision diagnostics increasingly guide repeat biopsy decisions, potentially reducing unnecessary procedures and focusing surveillance on higher-risk patients. Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will learn what CPT code 81551 represents clinically and operationally, the typical site of service and service type, and which major payers cover or evaluate the test. The publication summarizes common modifiers and highlights where input data are not available. It also provides context on clinical utility for patients with prior negative prostate biopsy and what stakeholders—laboratories, clinicians, and payers—typically consider when implementing or reviewing coverage for algorithm-based molecular tests. Policy, coding guidance, and reimbursement trends relevant to molecular risk-score assays are summarized for a national audience.