Summary & Overview
CPT 81452: Targeted Genomic Sequence Analysis Panel for Solid Organ Neoplasms
CPT code 81452 represents targeted genomic sequence analysis panels for solid organ neoplasms, analyzing DNA from 5 to 50 genes. This advanced laboratory procedure is pivotal in oncology, offering clinicians detailed genetic insights that inform diagnosis, prognosis, and personalized treatment plans for cancer patients. The code is widely recognized in national billing and reimbursement frameworks, reflecting the growing importance of molecular diagnostics in cancer care.
Key payers covered in this publication include Blue Cross Blue Shield, highlighting payer policies and coverage trends relevant to this code. Readers will gain an understanding of clinical benchmarks, policy updates, and the broader context of genomic testing in pathology and laboratory services. The publication also addresses common billing modifiers, associated physician taxonomies, and relevant ICD-10 diagnoses, providing a comprehensive overview for stakeholders in medical billing, laboratory operations, and oncology practice.
This summary offers a clear perspective on the role of 81452 in advancing precision medicine, its impact on payer coverage, and its integration into laboratory workflows. The information is designed to support healthcare professionals, administrators, and policy analysts seeking to stay informed about evolving standards in cancer genomics and laboratory billing.
CPT Code Overview
CPT code 81452 is used for targeted genomic sequence analysis panels focused on 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 is classified under Pathology and Laboratory, and is typically performed in a laboratory setting (Place of Service 81). This code enables clinicians to obtain detailed genetic profiles of tumors, supporting personalized treatment strategies and advancing precision medicine in oncology.
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 targeted genomic sequence analysis. The ordering physician, typically a medical oncologist or pathologist, requests a panel to analyze DNA from the tumor tissue for mutations in 5-50 genes relevant to the cancer type. The specimen is sent to a laboratory (Place of Service 81), where the test is performed. Results are used to guide prognosis, treatment selection, or eligibility for targeted therapies.
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 Name 207ZP0102XPathology Physician 207L00000XAnatomic Pathology & Clinical Pathology Physician 207RI0200XMedical Oncology Physician
These taxonomies represent providers specializing in pathology and medical oncology, who are typically involved in ordering, performing, or interpreting genomic sequence analysis panels.
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 targeted therapy.
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C18.9: Malignant neoplasm of colon, unspecified- Applied in colon cancer to detect genetic alterations for prognosis and treatment selection.
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C61: Malignant neoplasm of prostate- Pertinent for prostate cancer patients, supporting personalized medicine approaches.
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C25.9: Malignant neoplasm of pancreas, unspecified- Used in pancreatic cancer to identify genetic changes that may influence therapy options.
Each diagnosis code represents a solid organ neoplasm for which targeted genomic sequence analysis (81452) is clinically relevant.
Related CPT Codes
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81445: Targeted genomic sequence analysis panel, solid organ neoplasm, DNA analysis, 5-50 genes- Closely related to
81452, often used as an alternative depending on panel specifics.
- Closely related to
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88342: Immunohistochemistry, per specimen; initial single antibody stain procedure- Used to assess protein expression in tumor tissue, commonly performed alongside genomic analysis.
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88341: Immunohistochemistry, per specimen; each additional single antibody stain procedure- Used when multiple antibody stains are required, often in conjunction with genomic testing.
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88360: Morphometric analysis, tumor immunohistochemistry (e.g., HER-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative- Provides quantitative assessment of biomarkers, frequently used with genomic panels to inform treatment decisions.
These codes are commonly used together in comprehensive tumor profiling workflows or as alternatives based on clinical needs.
National Reimbursement Benchmarks
For CPT code 81452, the national mean rate for Blue Cross Blue Shield and BUCA (average commercial) is $80.02. Medicare rates are not available in the input for this code, so a direct comparison between commercial and Medicare rates cannot be made.
Rate dispersion across all payers is extremely tight, with the 25th, 50th, and 75th percentiles all at $80.00 for Blue Cross Blue Shield and BUCA. This indicates no variation in rates among these commercial payers. No data is available for Aetna, Cigna, UnitedHealth Group, or Medicare.
The table and chart below present the full breakdown of national mean rates and percentile values for each payer.
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