Summary & Overview
CPT 81451: Targeted Genomic Sequence Analysis Panel, Hematolymphoid RNA (5-50 Genes)
CPT code 81451 represents a targeted genomic sequence analysis panel for hematolymphoid neoplasms or disorders, focusing on RNA analysis of 5 to 50 genes. This advanced molecular genetic testing is crucial for the diagnosis and management of complex hematolymphoid diseases, offering clinicians precise genetic information to guide treatment decisions. The code is widely recognized and utilized in laboratory settings, reflecting the growing importance of molecular diagnostics in pathology.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, provide coverage for this procedure, underscoring its clinical relevance and widespread adoption. Readers will gain insights into payer coverage benchmarks, recent policy updates, and the clinical context surrounding the use of 81451. The publication also explores related codes, such as 81445, 81450, 81455, and 81456, to provide a comprehensive overview of targeted genomic testing options for hematolymphoid disorders.
Key topics include the role of molecular genetic testing in pathology, typical laboratory sites of service, and the importance of accurate coding for reimbursement and compliance. This summary equips healthcare professionals, billing specialists, and policy analysts with essential information on the utilization and coverage landscape for 81451, supporting informed decision-making in clinical and administrative settings.
CPT Code Overview
CPT code 81451 is used to report a targeted genomic sequence analysis panel for hematolymphoid neoplasms or disorders, specifically focusing on RNA analysis of 5 to 50 genes. This procedure falls under the Pathology / Molecular Genetic Testing service type and is typically performed in a laboratory setting (Place of Service 81). The test is designed to provide detailed genetic information that can assist in the diagnosis and management of hematolymphoid conditions, supporting clinical decision-making with advanced molecular insights.
Clinical & Coding Specifications
Clinical Context
A patient presents with clinical signs suggestive of a hematolymphoid neoplasm, such as unexplained cytopenias or abnormal blood counts. The treating physician, often a hematologist or oncologist, orders targeted genomic sequence analysis to identify specific RNA mutations across 5-50 genes relevant to hematolymphoid disorders. The specimen is sent to a laboratory (Place of Service 81), where a pathologist or molecular geneticist performs the analysis using CPT code 81451. The results inform diagnosis, prognosis, and potential therapeutic options for conditions like myelodysplastic disease.
Coding Specifications
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Modifiers:
- Modifier
26: Used when reporting only the professional component of the service (interpretation and report by the physician). - 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 Name 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, or interpreting molecular genetic tests.
Related Diagnoses
C94.6: Myelodysplastic disease, not elsewhere classified- This diagnosis is clinically relevant as it represents a group of hematologic disorders characterized by abnormal blood cell development. Targeted genomic sequence analysis using CPT code
81451helps identify specific genetic mutations associated with myelodysplastic syndromes, guiding diagnosis and management.
- This diagnosis is clinically relevant as it represents a group of hematologic disorders characterized by abnormal blood cell development. Targeted genomic sequence analysis using CPT code
Related CPT Codes
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81445: Targeted genomic sequence analysis panel, hematolymphoid neoplasm or disorder, DNA or RNA analysis, 5-50 genes- Used for DNA or RNA analysis panels covering 5-50 genes; may be chosen when both DNA and RNA are analyzed.
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81450: Targeted genomic sequence analysis panel, hematolymphoid neoplasm or disorder, DNA analysis, 5-50 genes- Used for DNA-only analysis panels covering 5-50 genes; alternative to
81451when only DNA is tested.
- Used for DNA-only analysis panels covering 5-50 genes; alternative to
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81455: Targeted genomic sequence analysis panel, hematolymphoid neoplasm or disorder, DNA or RNA analysis, 51+ genes- Used for larger panels (51+ genes) involving DNA or RNA analysis; may be used when broader testing is clinically indicated.
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81456: Targeted genomic sequence analysis panel, hematolymphoid neoplasm or disorder, RNA analysis, 51+ genes- Used for RNA-only analysis panels covering 51+ genes; alternative to
81451for larger RNA panels.
- Used for RNA-only analysis panels covering 51+ genes; alternative to
These codes are related by the type of genetic material analyzed (DNA, RNA, or both) and the number of genes included. They are selected based on clinical need and laboratory capabilities. Codes may be used as alternatives or in sequence, depending on the scope of testing required.
National Reimbursement Benchmarks
National mean rates for CPT code 81451 show that Blue Cross Blue Shield, Cigna, and BUCA (average commercial) all reimburse at higher levels than Aetna and UnitedHealth Group. Cigna has the highest mean rate at $716.04, while Aetna is the lowest among the commercial payers at $578.66. The BUCA mean rate stands at $627.80, which is above Aetna and UnitedHealth Group but below Cigna.
Rate dispersion varies significantly across payers. Cigna exhibits the widest spread, with a difference of $530.00 between its 75th and 25th percentiles, indicating substantial variability in reimbursement. UnitedHealth Group has the tightest range at $372.00, suggesting more consistent rates. The table and chart below present the full breakdown of national benchmarks 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.