Summary & Overview
CPT 81552: 15-Gene mRNA Expression Profiling for Uveal Melanoma Risk
CPT code 81552 represents a molecular diagnostic assay that performs mRNA expression profiling of 15 genes and uses an algorithmic analysis with patient data to generate a metastasis risk score for uveal melanoma. This test is clinically significant because it stratifies patients by metastatic risk, informing prognosis and potential surveillance strategies. As precision oncology services become more common, national coverage and payment policies for genomic risk assays are increasingly relevant to laboratories, oncologists, and payers.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes payer coverage patterns, coding and billing considerations, and relevant clinical context for uveal melanoma molecular prognostics. Readers will find benchmarks for utilization and reimbursement where available, summaries of policy language and coverage criteria, and a concise clinical description of the test’s role in risk stratification. The report also highlights typical sites of service and operational considerations for labs offering the assay.
Data not available in the input includes specific coverage policies, reimbursement rates, associated taxonomies, and ICD-10 diagnosis mappings. The content is presented for a national audience and focuses on the clinical and billing identity of CPT code 81552, plus what stakeholders need to know about payer engagement and coding use.
Billing Code Overview
CPT code 81552 describes a laboratory service that performs mRNA gene expression profiling for 15 genes and applies an algorithmic analysis combining patient data and lab results to report a risk score for uveal melanoma metastasis. The service type is molecular diagnostic testing with algorithmic/analytics interpretation. The typical site of service is a clinical molecular diagnostics laboratory or reference lab performing high-complexity testing.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient presents to an ophthalmic oncology clinic after enucleation of an eye for a primary uveal melanoma confirmed on histopathology. The ocular surgeon submits the formalin-fixed, paraffin-embedded tumor specimen or a dedicated tissue sample to a CLIA-certified molecular diagnostics laboratory for mRNA gene expression profiling. The laboratory performs 81552 testing: extraction of RNA, measurement of expression across a 15-gene panel, and application of a validated algorithm that integrates the gene-expression results with patient and tumor variables to generate a metastasis risk score. The lab returns a report indicating low- or high-risk of metastatic disease, which the ocular oncologist uses for prognosis counseling and surveillance planning. Typical site of service is an outpatient pathology/molecular laboratory receiving specimens from ambulatory surgical centers or hospital outpatient departments. Typical workflow steps: specimen collection and accessioning, specimen preparation and shipping (if off-site), laboratory technical processing (RNA extraction and expression assay), bioinformatic/algorithmic analysis, report generation, and secure transmission of results to the ordering ophthalmologist and inclusion in the patient’s medical record.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use if reporting only the professional component when applicable and separately billable by the laboratory director or pathologist for interpretation or oversight. |