Summary & Overview
CPT 81423: Genomic Sequence Analysis Panel for Solid Organ Neoplasms
CPT code 81423 represents a genomic sequence analysis panel for solid organ neoplasms, focusing on DNA analysis of 5-50 genes. This code is significant in the national landscape of oncology diagnostics, as it enables detailed molecular profiling of tumors, which is critical for guiding targeted therapies and improving patient outcomes. The procedure is classified under Pathology and Laboratory services and is most commonly performed in laboratory settings.
Blue Cross Blue Shield is a key payer covering this code, reflecting its importance in commercial insurance coverage for advanced cancer diagnostics. Readers will gain insights into clinical benchmarks, policy updates, and the broader context of genomic testing in cancer care. The publication also addresses relevant modifiers, associated taxonomies, ICD-10 diagnoses, and related CPT codes, providing a comprehensive overview for stakeholders involved in medical billing, coding, and policy analysis. Understanding the scope and application of CPT code 81423 is essential for navigating reimbursement and compliance in the evolving field of molecular pathology.
CPT Code Overview
CPT code 81423 is used for genomic sequence analysis panels targeting solid organ neoplasms. This procedure involves DNA analysis of 5-50 genes to identify genetic mutations relevant to cancer diagnosis and treatment. The service falls under Pathology and Laboratory and is typically performed in a laboratory setting (Place of Service 81). This code is essential for comprehensive molecular profiling of tumors, supporting precision medicine approaches in oncology.
Clinical & Coding Specifications
Clinical Context
A patient with a newly diagnosed solid organ neoplasm, such as lung, breast, colon, prostate, or pancreatic cancer, is referred for advanced molecular testing. The treating oncologist or pathologist orders genomic sequence analysis to evaluate the tumor's DNA for mutations across a panel of 5-50 genes. The specimen is sent to a laboratory (Place of Service 81), where the test is performed to guide targeted therapy, prognosis, or further diagnostic workup. Results are interpreted by a pathology or oncology physician and integrated into the patient's care plan.
Coding Specifications
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Modifiers:
- Modifier
26: Used when reporting only the professional component (interpretation of results) of the procedure. - Modifier
TC: Used when reporting only the technical component (performance of the test in the laboratory).
- Modifier
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Provider Taxonomies:
Code Specialty 207ZP0102XPathology Physician 207L00000XAnatomic Pathology & Clinical Pathology Physician 207RI0200XMedical Oncology Physician
These taxonomies represent providers specializing in pathology and oncology, who are typically involved in ordering, performing, and interpreting genomic sequence analysis for neoplasms.
Related Diagnoses
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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.
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C50.919: Malignant neoplasm of unspecified site of unspecified female breast- Used for breast cancer cases where genomic profiling may guide therapy selection.
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C18.9: Malignant neoplasm of colon, unspecified- Indicates colon cancer, for which genomic testing can inform targeted treatment options.
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C61: Malignant neoplasm of prostate- Applied in prostate cancer to assess genetic alterations that may impact management.
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C25.9: Malignant neoplasm of pancreas, unspecified- Used for pancreatic cancer, where genomic analysis can help identify potential therapeutic targets.
Each diagnosis code represents a solid organ neoplasm for which genomic sequence analysis (81423) is clinically relevant to guide personalized oncology care.
Related CPT Codes
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88342: Immunohistochemistry, per specimen- Used to detect specific proteins in tumor tissue, often performed alongside genomic analysis to further characterize neoplasms.
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88341: Immunohistochemistry, each additional single antibody stain- Applied when multiple antibody stains are needed for comprehensive tumor profiling, commonly used with
88342.
- Applied when multiple antibody stains are needed for comprehensive tumor profiling, commonly used with
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81235: EGFR gene analysis, common variants- Focuses on EGFR mutations, which may be included in the broader panel of
81423or ordered separately for specific clinical indications.
- Focuses on EGFR mutations, which may be included in the broader panel of
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81445: Targeted genomic sequence analysis panel, 5-50 genes, neoplasm- Similar to
81423, used for targeted panels; may be an alternative or complement depending on the clinical scenario and payer requirements.
- Similar to
These codes are often used together in the diagnostic workflow for solid organ neoplasms, providing molecular and immunohistochemical data to inform treatment decisions.
National Reimbursement Benchmarks
National mean rates for CPT code 81423 are identical between Blue Cross Blue Shield and BUCA (average commercial), both at $80.02. Medicare rates are not available in the input for comparison.
Rate dispersion is minimal across both commercial payers, with the 25th, 50th, and 75th percentiles all at $80.00. This indicates a very tight reimbursement range, with no variation between the lower and upper quartiles.
The table and chart below present the full breakdown of national mean rates and percentile values for each payer.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.