CPT Code Overview

CPT code 81413 is used to report a genomic sequence analysis panel for solid organ neoplasms, specifically DNA analysis involving 5 to 50 genes. This procedure falls under the Pathology and Laboratory service type and is typically performed in an Independent Laboratory setting (Place of Service 81). The test is designed to provide comprehensive genetic information that can inform diagnosis and treatment decisions for patients with solid organ tumors.

Clinical Context

A patient with a newly diagnosed solid organ malignancy, such as lung, breast, colon, prostate, or pancreatic cancer, is referred for advanced molecular testing. The treating oncologist requests a genomic sequence analysis panel to identify mutations in 5-50 genes relevant to the tumor type. The specimen, typically a tissue biopsy, is sent to an independent laboratory (Place of Service 81) specializing in pathology and molecular diagnostics. The laboratory performs DNA analysis using CPT code 81413 to guide targeted therapy and inform prognosis. Results are interpreted by a pathologist or molecular oncologist and reported back to the treating physician for clinical decision-making.

Coding Specifications

• Modifiers:

  • Modifier 26: Used to indicate the professional component, which covers the interpretation and reporting of the genomic sequence analysis by a qualified physician or pathologist.

  • Modifier TC: Used to indicate the technical component, which covers the performance of the laboratory test, including specimen processing and DNA sequencing.

• Provider Taxonomies:

  Taxonomy Code	Specialty Name
  207ZP0102X	Pathology
  207L00000X	Anatomic Pathology
  207RI0200X	Internal Medicine - Medical Oncology

• Specialties Represented:

  • Pathology: Laboratory analysis and interpretation of genomic data.

  • Anatomic Pathology: Tissue-based diagnostics and molecular testing.

  • Internal Medicine - Medical Oncology: Clinical management and application of genomic results for cancer treatment.

Related Diagnoses

• C34.90 - Malignant neoplasm of unspecified part of unspecified bronchus or lung

  • Relevant for patients with lung cancer undergoing genomic analysis to identify actionable mutations.

• C50.919 - Malignant neoplasm of unspecified site of unspecified female breast

  • Used for breast cancer cases where genomic sequencing may guide targeted therapy.

• C18.9 - Malignant neoplasm of colon, unspecified

  • Applied to colon cancer patients for molecular profiling and treatment selection.

• C61 - Malignant neoplasm of prostate

  • Indicates prostate cancer, where genomic testing can inform prognosis and therapy options.

• C25.9 - Malignant neoplasm of pancreas, unspecified

  • Used for pancreatic cancer, supporting personalized medicine through genomic analysis.

Related CPT Codes

• 81445 - Targeted genomic sequence analysis panel, solid organ neoplasm, DNA analysis, 5-50 genes

  • Used for targeted panels focusing on specific genes; may be an alternative to 81413 depending on clinical requirements.

• 88342 - Immunohistochemistry, per specimen; initial single antibody stain procedure

  • Often performed alongside genomic testing to assess protein expression in tumor tissue.

• 88341 - Immunohistochemistry, per specimen; each additional single antibody stain procedure

  • Used when multiple antibody stains are required, complementing genomic analysis.

• 88360 - Morphometric analysis, tumor immunohistochemistry (e.g., HER-2/neu), quantitative or semiquantitative

  • Provides quantitative assessment of tumor markers, frequently used in conjunction with genomic sequencing for comprehensive tumor profiling.

These codes are commonly used together in the diagnostic workflow for solid organ neoplasms, with 81413 or 81445 for genomic analysis and 88342, 88341, 88360 for immunohistochemical evaluation.

National mean rates for CPT code 81413 among commercial payers (BUCA) average $522.76, while individual payer rates range from $490.45 for Aetna to $588.72 for Cigna. Medicare rates are not available in the input, so only commercial benchmarks are presented.

Rate dispersion varies significantly across payers. Cigna shows the widest spread, with a difference of $458.67 between its 75th and 25th percentiles, indicating substantial variability in reimbursement. UnitedHealth Group has the tightest range, with a $291.50 difference, suggesting more consistent rates. The table and chart below present the full breakdown of national benchmarks for each payer.