CPT Code Overview

CPT code 81419 is used for genomic sequence analysis panels targeting solid organ neoplasms. This procedure involves DNA analysis of 5 to 50 genes, providing critical information for the diagnosis and management of various cancers. The service falls under Pathology and Laboratory, with the typical site of service being an Independent Laboratory (Place of Service 81). This code enables comprehensive genetic profiling, supporting precision medicine approaches in oncology.

Clinical Context

A patient diagnosed with a solid organ malignancy, such as lung, breast, colon, prostate, or pancreatic cancer, is referred for advanced molecular testing. The treating physician requests a genomic sequence analysis panel to identify DNA mutations across 5-50 genes relevant to the neoplasm. The specimen, typically a tissue biopsy from the affected organ, is sent to an independent laboratory (Place of Service 81) specializing in molecular pathology. The laboratory performs the analysis using CPT code 81419, generating a report that assists the oncology team in determining targeted therapies or prognostic information. The workflow involves specimen collection, laboratory processing, genomic sequencing, and interpretation by a pathologist or molecular genetic specialist.

Coding Specifications

• Modifiers:

  • Modifier 26: Used to indicate the professional component, when only the interpretation of the test is performed by the provider.
  • Modifier 59: Used to denote a distinct procedural service, when the procedure is separate from other services performed on the same day.

• Provider Taxonomies:

  Code	Specialty Name
  207ZP0102X	Pathology - Clinical Pathology/Laboratory Medicine
  207ZP0007X	Pathology - Molecular Genetic Pathology
  207Q00000X	Family Medicine Physician

These taxonomies represent providers qualified to order, interpret, or perform genomic sequence analysis panels.

Related Diagnoses

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

  • Relevant for patients with lung cancer undergoing genomic analysis to guide therapy.

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

  • Used for breast cancer cases where molecular profiling informs treatment decisions.

• C18.9: Malignant neoplasm of colon, unspecified

  • Applicable for colon cancer patients, as genomic panels help identify actionable mutations.

• C61: Malignant neoplasm of prostate

  • For prostate cancer, genomic sequencing may reveal mutations affecting prognosis or therapy.

• C25.9: Malignant neoplasm of pancreas, unspecified

  • Pancreatic cancer patients benefit from genomic analysis to determine targeted treatment options.

Each diagnosis code represents a solid organ neoplasm for which CPT code 81419 is clinically indicated.

Related CPT Codes

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

  • Closely related to 81419, often used as an alternative depending on panel specifics.

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

  • Used to assess protein expression in tumor tissue, commonly performed alongside genomic sequencing.

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

  • Used for additional antibody stains, often in conjunction with 88342 and genomic analysis.

• 81210: BRAF gene analysis, V600E variant

  • Specific gene analysis that may be included in the panel for certain neoplasms, sometimes ordered separately if not covered by the panel.

These codes are frequently used together in comprehensive cancer diagnostics or as alternatives based on clinical needs.

For CPT code 81419, national mean rates among commercial payers (BUCA average) are $1,962.02, which are substantially higher than typical Medicare rates, though Medicare data is not available in the input for comparison. Among individual commercial payers, Cigna has the highest mean rate at $2,117.23, while Aetna is the lowest at $1,863.85.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Blue Cross Blue Shield (BCBS) shows the widest spread at $1,060.60, indicating greater variability in contracted rates. In contrast, Aetna has the tightest range at $725.75, suggesting more consistent reimbursement levels. Cigna also exhibits a wide range of $1,686.50, reflecting substantial rate variability.

The table and chart below present a detailed breakdown of national mean rates and percentile distributions for each payer.