Summary & Overview
CPT 81454: Targeted Genomic Sequence Analysis Panel for Solid Organ Neoplasms
CPT code 81454 represents a targeted genomic sequence analysis panel for solid organ neoplasms, analyzing DNA from 5 to 50 genes. This advanced laboratory procedure is pivotal in oncology, offering precise genetic insights that inform diagnosis, prognosis, and personalized treatment plans for patients with cancers such as lung, breast, colon, prostate, and pancreas. The code is primarily utilized in independent laboratory settings, reflecting the growing role of molecular pathology in cancer care.
Blue Cross Blue Shield is a key payer covering this service, highlighting its national relevance and widespread adoption. Readers will gain an understanding of the clinical context for 81454, including its application in cancer diagnostics, typical laboratory workflow, and associated billing practices. The publication also provides benchmarks and policy updates relevant to pathology and laboratory services, helping stakeholders stay informed about evolving trends in genomic testing.
This summary offers a comprehensive overview of 81454, its significance in modern oncology, and the payer landscape, equipping healthcare professionals, administrators, and policy analysts with essential information for decision-making and operational planning.
CPT Code Overview
CPT code 81454 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 an Independent Laboratory setting (Place of Service 81). This code enables clinicians to obtain detailed genetic profiles of tumors, supporting personalized treatment strategies and improving patient outcomes.
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 requests DNA analysis of 5-50 genes to identify mutations relevant for prognosis or targeted therapy. The specimen is sent to an independent laboratory (Place of Service 81), where a pathologist specializing in molecular genetic pathology oversees the testing. The results inform treatment decisions, such as eligibility for targeted therapies or clinical trials.
Coding Specifications
-
Modifiers:
- Modifier
26: Used when billing for the professional component, which includes interpretation and reporting by the pathologist. - Modifier
TC: Used when billing for the technical component, which covers the laboratory processing and analysis of the specimen.
- Modifier
-
Provider Taxonomies:
Taxonomy Code Specialty Name 207ZP0102XPathology - Clinical Pathology/Laboratory Medicine 207ZP0105XPathology - Molecular Genetic Pathology 207L00000XAnatomic Pathology & Clinical Pathology
These taxonomies represent providers specializing in laboratory medicine, molecular genetic pathology, and anatomic pathology.
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 targeted genomic testing may inform treatment options.
-
C18.9: Malignant neoplasm of colon, unspecified- Applies to colon cancer patients, supporting molecular profiling for personalized medicine.
-
C61: Malignant neoplasm of prostate- For prostate cancer, genomic analysis can identify actionable mutations.
-
C25.9: Malignant neoplasm of pancreas, unspecified- Used in pancreatic cancer scenarios to determine genetic alterations for targeted therapies.
Each diagnosis code represents a solid organ neoplasm for which targeted genomic sequence analysis is clinically relevant.
Related CPT Codes
-
88342: Immunohistochemistry, per specimen- Used to detect specific proteins in tissue samples, often performed alongside genomic analysis to further characterize neoplasms.
-
88341: Immunohistochemistry, each additional single antibody stain- Applied when multiple antibody stains are needed, commonly used in conjunction with
88342.
- Applied when multiple antibody stains are needed, commonly used in conjunction with
-
81445: Targeted genomic sequence analysis panel, solid organ neoplasm, DNA analysis, 5-50 genes- Similar to
81454, may be used as an alternative depending on panel specifics.
- Similar to
-
81210: BRAF gene analysis, V600E variant- Focuses on a single gene mutation, often ordered when a specific mutation is suspected or as a follow-up to broader panel testing.
These codes are commonly used together in the diagnostic workflow for solid organ neoplasms, with 81454 serving as the primary panel and others supplementing or providing alternative testing options.
National Reimbursement Benchmarks
Nationally, Blue Cross Blue Shield and BUCA (average commercial) both reimburse CPT code 81454 at a mean rate of $80.02. Medicare rates are not available in the input for comparison. The mean rates for these commercial payers are identical, indicating uniformity in national pricing for this code.
Rate dispersion is minimal across both Blue Cross Blue Shield and BUCA, with the 25th, 50th, and 75th percentiles all at $80.00. This tight range suggests little variation in reimbursement rates among providers for these payers. The table and chart below present the full breakdown of national benchmarks for CPT code 81454.
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.