Summary & Overview
CPT 81441: Genomic Sequence Analysis Panel for Solid Organ Neoplasms
CPT code 81441 represents a genomic sequence analysis panel for solid organ neoplasms, focusing on DNA analysis of 5 to 50 genes. This code is significant in the national landscape as it supports precision medicine approaches in oncology, enabling clinicians to identify genetic mutations that may influence treatment decisions for various cancers. The procedure is categorized under Pathology and Laboratory services and is most commonly performed in independent laboratory settings.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, provide coverage for this code, reflecting its widespread clinical adoption and relevance. Readers will gain insights into payer coverage, clinical indications, and related coding practices, including common modifiers and associated taxonomies. The publication also highlights relevant ICD-10 diagnoses, such as malignant neoplasms of the lung, breast, colon, prostate, and pancreas, which are frequently linked to the use of this genomic panel.
Key benchmarks and policy updates are discussed, offering a comprehensive overview of how CPT code 81441 fits into current laboratory and pathology billing practices. The article also explores related CPT codes and the clinical context for genomic testing in oncology, providing readers with a clear understanding of the code's role in advancing cancer diagnostics and personalized care.
CPT Code Overview
CPT code 81441 is used for genomic sequence analysis panels targeting 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 strategies for patients with solid organ tumors.
Clinical & Coding Specifications
Clinical Context
A patient diagnosed with a solid organ neoplasm, 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. 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 81441 to guide targeted therapy decisions and inform prognosis. Results are interpreted by a pathologist or molecular oncologist and reported back to the treating physician.
Coding Specifications
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Modifiers:
- Modifier
26: Used when billing for the professional component, which includes interpretation and reporting of results by a qualified physician. - Modifier
TC: Used when billing for the technical component, which covers the laboratory's performance of the genomic sequencing procedure.
- Modifier
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207ZP0102X | Pathology |
207L00000X | Anatomic Pathology |
207RI0200X | Internal Medicine - Medical Oncology |
- Specialties Represented:
- Pathologists
- Anatomic Pathologists
- Medical Oncologists
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 sequencing 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 molecular profiling guides therapy selection.
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C18.9- Malignant neoplasm of colon, unspecified- Applied in colon cancer to detect genetic alterations for targeted treatment.
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C61- Malignant neoplasm of prostate- Supports prostate cancer management through identification of genetic variants.
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C25.9- Malignant neoplasm of pancreas, unspecified- Used in pancreatic cancer to inform prognosis and potential targeted therapies.
Related CPT Codes
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88342- Immunohistochemistry, per specimen- Used to detect specific proteins in tumor tissue, often performed alongside genomic sequencing to provide complementary diagnostic information.
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88341- Immunohistochemistry, each additional single antibody stain- Applied when multiple antibody stains are needed for a specimen, commonly used with
88342.
- Applied when multiple antibody stains are needed for a specimen, commonly used with
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81235- EGFR gene analysis, common variants- Focuses on EGFR mutations, which may be included in broader panels like
81441or ordered separately for lung cancer cases.
- Focuses on EGFR mutations, which may be included in broader panels like
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81445- Targeted genomic sequence analysis panel, 5-50 genes- Similar to
81441, but may differ in panel composition or methodology; used as an alternative or in conjunction depending on clinical needs.
- Similar to
-
Commonly Used Together:
88342and88341are often performed with81441for comprehensive tumor profiling.81235may be ordered separately or as part of the panel in81441.81445serves as an alternative to81441for targeted sequencing panels.
National Reimbursement Benchmarks
Nationally, the mean rate for CPT code 81441 among BUCA (average commercial) payers is $2,012.72, which is substantially higher than the typical Medicare rate for similar codes. Commercial payers such as Cigna and Blue Cross Blue Shield show the highest mean rates, with Cigna reaching $2,286.29.
Rate dispersion varies significantly across payers. Cigna exhibits the widest spread, with a difference of $1,697.00 between its 75th and 25th percentiles, indicating greater variability in contracted rates. In contrast, Aetna has the tightest range at $725.75, suggesting more consistent reimbursement levels. Blue Cross Blue Shield and UnitedHealth Group fall in between, with ranges of $853.10 and $1,176.00, respectively.
The table and chart below present a detailed 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.