CPT 83951: Des Gamma Carboxy Prothrombin (Hepatocellular Carcinoma Marker) - OpenPayer

Summary & Overview

CPT 83951: Des Gamma Carboxy Prothrombin (Hepatocellular Carcinoma Marker)

CPT code 83951 designates the laboratory measurement of des gamma carboxy prothrombin, an oncoprotein measured in serum and used primarily for risk assessment of hepatocellular carcinoma. As a specialized tumor marker assay, this code represents a targeted diagnostic tool in liver oncology that supports clinical decision-making about surveillance and risk stratification.

Key national payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides readers with a concise clinical context for the test, common sites of service, and the types of information payers consider when covering specialized laboratory oncology assays.

Readers will learn the clinical rationale for the test, typical service delivery settings, and what to expect in payer coverage discussions and coding workflows. Where available, the report summarizes benchmarks and policy considerations relevant to laboratory oncology testing. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare83951CPTlaboratorytumor-markerhepatocellular-carcinomaoncologyserum-assayclinical-laboratorydiagnostic-testing

Billing Code Overview

CPT code 83951 reports measurement of des gamma carboxy prothrombin oncoprotein, typically performed on a serum specimen. The assay is used by clinicians for risk assessment of hepatocellular carcinoma and other evaluations related to liver oncology.

Service type: Laboratory test — oncologic tumor marker assay
Typical site of service: Clinical laboratory or hospital laboratory (serum specimen collection and analysis)

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient with chronic hepatitis C and cirrhosis is seen in hepatology clinic for routine hepatocellular carcinoma (HCC) surveillance. The clinician orders serum tumor marker testing, including the des-gamma-carboxy prothrombin (DCP) assay to augment ultrasound imaging and alpha-fetoprotein monitoring. A phlebotomist collects a serum specimen and sends it to the clinical laboratory. The laboratory analyst performs the 83951 assay, measuring des-gamma-carboxy prothrombin oncoprotein from the serum sample and reports a quantitative result to the ordering provider. Results are used together with imaging and clinical assessment for HCC risk stratification and surveillance planning. Typical site of service: outpatient clinic or hospital laboratory; service type: clinical laboratory pathology/chemistry assay.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the professional interpretation component if separate from the laboratory technical component.
`TC`	Technical component	Use when billing only the technical/laboratory component of the test.

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Taxonomy Code	Specialty	Notes
`207RH0000X`	Hematology & Oncology	Hematology/oncology clinicians order DCP testing for HCC risk assessment.
`208000000X`	Gastroenterology	Gastroenterologists/hepatologists manage patients with chronic liver disease and order surveillance tests.
`363LF0000X`	Laboratory Director	Clinical pathologists or laboratory medicine specialists oversee assay performance and reporting.
`207P00000X`	Infectious Disease	Infectious disease specialists managing chronic viral hepatitis may order tumor marker surveillance.
`207K00000X`	Internal Medicine	Primary care and internal medicine physicians coordinate surveillance and ordering of laboratory tests.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C22.0`	Hepatocellular carcinoma	Primary diagnosis for which `83951` may be used in diagnosis, staging, or surveillance.
`B18.2`	Chronic viral hepatitis C	A common underlying condition that increases HCC risk and prompts DCP testing as part of surveillance.
`K74.60`	Unspecified cirrhosis of liver	Cirrhosis is a major risk factor for HCC and common indication for DCP testing.
`K76.0`	Fatty (change of) liver, not elsewhere classified	Nonalcoholic fatty liver disease with advanced fibrosis can prompt HCC surveillance including tumor markers.
`R16.0`	Hepatomegaly	Clinical finding that may trigger further evaluation including tumor marker measurement and imaging.
`Z08`	Follow-up examination after treatment for malignant neoplasm	Used when monitoring for recurrent HCC after curative therapy; DCP may be included in surveillance panels.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`80053`	Comprehensive metabolic panel; 14 tests	Common concurrent laboratory panel to assess liver function and metabolic status when evaluating HCC risk.
`82306`	Alpha fetoprotein (AFP); serum	Frequently ordered alongside `83951` to improve detection and surveillance for hepatocellular carcinoma.
`76977`	Ultrasound guidance for needle placement (e.g., biopsy)	Imaging guidance code used when an abnormal marker or imaging prompts liver lesion biopsy; complements tumor marker testing.
`47000`	Biopsy of liver, percutaneous, needle	Performed when imaging and tumor markers suggest a lesion requiring histologic diagnosis; follows noninvasive testing.
`88305`	Level IV surgical pathology, gross and microscopic examination	Pathology CPT for analysis of liver biopsy specimens obtained after abnormal surveillance findings.

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