Summary & Overview
CPT 81455: Genomic Sequencing Panel for 51+ Gene Neoplasm Analysis
CPT 81455 represents an advanced genomic sequencing panel for solid organ and hematolymphoid neoplasms that assesses 51 or more genes for sequence variants, copy number changes, rearrangements, and, when performed, isoform or mRNA expression. At a national level, this code reflects the growing clinical adoption of broad sequencing panels in oncology and hematopathology to guide diagnosis, prognosis, and targeted therapy selection. Major commercial payers commonly engaged with this service include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Readers will find a concise overview of the clinical scope and laboratory setting for this procedure, comparisons to related targeted panels, and payer coverage context. The publication provides benchmarks on typical use cases, summarizes relevant clinical indications tied to hematologic and solid tumor diagnoses, and outlines common billing elements such as professional and technical components. It also identifies gaps where data were not provided in the input. This summary is intended to inform laboratory administrators, coding professionals, and policy analysts about the clinical purpose of CPT 81455, payer engagement, and peripheral billing considerations tied to genomic sequencing procedures.
CPT Code Overview
CPT 81455 describes a comprehensive genomic sequencing panel for solid organ or hematolymphoid neoplasms or disorders that evaluates 51 or greater genes. The panel performs genomic sequence analysis to interrogate sequence variants and copy number variants or rearrangements, and may include isoform expression or mRNA expression levels if performed. This procedure falls under Pathology/Laboratory – Genomic Sequencing Procedures and is typically performed in a laboratory setting (POS 81).
Clinical & Coding Specifications
A patient with a diagnosed or suspected hematolymphoid neoplasm (for example chronic myeloid leukemia, acute myeloid leukemia, chronic lymphocytic leukemia, or myelodysplastic disease) undergoes comprehensive genomic sequencing to inform prognosis, targeted therapy selection, or detection of residual disease. A peripheral blood or bone marrow specimen is collected and sent to the laboratory (POS 81). In the laboratory, a molecular pathology team performs a genomic sequence analysis panel interrogating 51 or greater genes for sequence variants and copy number variants, and, if indicated, rearrangements or RNA expression. Results are reported to the treating hematologist/oncologist and incorporated into the patient’s treatment planning and disease monitoring.
Modifier 26 (Professional Component): Use when billing for the professional interpretation and report by a qualified laboratory professional separate from the technical work. Modifier TC (Technical Component): Use when billing for the technical component only (laboratory processing, instrumentation, reagents, and technical staff).
- Associated provider taxonomies:
| Taxonomy Code | Taxonomy Name | Specialty Represented |
|---|---|---|
207ZP0102X | Pathology - Clinical Pathology/Laboratory Medicine | Clinical pathology and laboratory medicine services, including oversight of laboratory testing and interpretation |
207ZP0007X | Pathology - Molecular Genetic Pathology | Molecular genetic pathology, including genomic sequencing and molecular diagnostic interpretation |
207L00000X | Anatomic Pathology & Clinical Pathology | Combined anatomic and clinical pathology practice, encompassing histopathology and laboratory diagnostics |
All provided ICD-10 diagnoses:
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C92.01— Chronic myeloid leukemia of BCR/ABL-positive, in remissionClinical relevance: Remission monitoring or detection of residual disease may prompt comprehensive genomic testing to identify persistent mutations or secondary alterations.
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C92.41— Chronic lymphocytic leukemia of B-cell, without mention of having achieved remissionClinical relevance: Genomic profiling can identify prognostic mutations and inform therapy selection for active disease.
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C92.51— Other specified myeloid leukemiaClinical relevance: Broad genomic panels help classify specific molecular subtypes and guide targeted treatment decisions.
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C92.61— Acute myeloid leukemia, not having achieved remissionClinical relevance: Comprehensive sequencing identifies actionable mutations and informs prognosis and treatment planning in refractory or active AML.
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C92.Z1— Myeloid leukemia, unspecifiedClinical relevance: When the leukemia subtype is unclear, large-panel genomic analysis can assist in characterization and diagnostic clarification.
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C92.91— Myeloid leukemia, not specified as acute or chronicClinical relevance: Genomic testing supports subclassification and therapeutic decision-making when clinical features are ambiguous.
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C93.01— Acute monoblastic leukemiaClinical relevance: Molecular profiling can detect mutations relevant to prognosis and targeted therapy in this AML subtype.
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C94.01— Myelodysplastic disease, unspecifiedClinical relevance: Genomic panels identify somatic mutations associated with myelodysplastic syndromes, aiding diagnosis, risk stratification, and management.
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C94.21— Other specified myelodysplastic diseaseClinical relevance: Detailed genomic analysis informs subtype classification and potential therapeutic targets.
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C92.10— Chronic myeloid leukemia BCR/ABL-positive, not having achieved remissionClinical relevance: Testing may identify additional mutations or resistance mechanisms influencing therapy.
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C92.11— Chronic myeloid leukemia BCR/ABL-positive, in remissionClinical relevance: Surveillance sequencing may be performed to detect minimal residual disease or emergent clones.
All related CPT codes provided:
| CPT Code | Description | Relationship to 81455 |
|---|---|---|
81445 | Targeted genomic sequence analysis panel, solid organ neoplasm type (5‑50 genes) | A smaller targeted DNA panel for solid tumor genes; used as an alternative when fewer genes are required or when testing is focused on solid organ neoplasms |
81450 | Targeted genomic sequence analysis panel, hematolymphoid neoplasm type (5‑50 genes) | A smaller targeted panel for hematolymphoid neoplasms; an alternative to 81455 when a 5–50 gene panel suffices |
81449 | Targeted genomic sequence RNA analysis (solid organ neoplasm, separate method) | RNA-based targeted analysis for fusion transcripts or expression in solid tumors; may complement DNA-based panels when RNA-level data are needed |
81451 | Targeted genomic sequence RNA analysis (hematolymphoid neoplasm, separate method) | RNA-based targeted analysis for hematolymphoid neoplasms; may be ordered alongside DNA panels for detection of fusions or transcript variants |
81456 | Targeted genomic sequence RNA analysis panel, 51 or greater genes | A large RNA expression or fusion panel analogous to 81455 but focused on RNA analysis; may be used together with or as an alternative to DNA-based large panels |
Notes on clinical workflow: 81445 and 81450 are commonly used alternatives when a smaller, targeted DNA panel (5–50 genes) is appropriate. 81449, 81451, and 81456 represent RNA-based assays that may be ordered in conjunction with DNA panels when detection of fusion genes or expression profiling is required. 81455 is used when comprehensive DNA-based interrogation of 51 or more genes is indicated.
National Reimbursement Benchmarks
National mean allowed rates for 81455 show that BUCA (the aggregated commercial benchmark) has a higher average mean ($2,132.96) than Medicare (average commercial vs Medicare comparison: Medicare mean not provided in the input), indicating commercial means exceed Medicare in this dataset. The BUCA mean sits above several individual commercial payers but below the highest commercial means.
Rate dispersion (P75 minus P25) varies across payers: Cigna exhibits the widest spread (approximately $2,512.93), reflecting substantial variation in allowed amounts, while Aetna shows a relatively tight distribution (approximately $1,762.00). BCBS and UnitedHealth Group have moderate dispersion, and BUCA’s spread is also moderate. The table and chart below present the full breakdown of mean rates and percentiles by payer.
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