Summary & Overview
CPT 81457: Genomic Sequence Analysis Panel for Solid Organ Neoplasms
CPT code 81457 is a pivotal billing code for genomic sequence analysis panels targeting solid organ neoplasms. This code is used by diagnostic laboratories to interrogate sequence variants in tumor samples, providing essential molecular insights for cancer diagnosis and treatment planning. The procedure is part of the broader molecular pathology and genomic sequencing service line, reflecting the growing importance of precision medicine in oncology.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, recognize and reimburse for this code, underscoring its clinical and financial relevance across the United States. The publication offers a comprehensive overview of payer coverage, clinical indications, and related coding practices, equipping readers with up-to-date benchmarks and policy updates. It also contextualizes 81457 within the landscape of genomic testing, highlighting its role alongside related CPT codes for both DNA- and RNA-based panels.
Readers will gain insights into the clinical context for use, typical laboratory settings, and the spectrum of associated diagnoses, such as various malignant neoplasms of the gastrointestinal tract. The summary also addresses common modifiers and taxonomies relevant to billing and compliance. This resource is designed for healthcare professionals, laboratory administrators, and policy analysts seeking a clear understanding of 81457 and its place in modern cancer care.
CPT Code Overview
CPT code 81457 represents a solid organ neoplasm genomic sequence analysis panel, specifically designed for the interrogation of sequence variants. This procedure falls under the molecular pathology and genomic sequencing procedures service type. It is typically performed in a diagnostic laboratory setting, such as a CLIA-certified lab, where advanced genomic technologies are used to analyze tumor samples from solid organs. The test provides critical information for the diagnosis and management of cancer by identifying genetic mutations that may influence treatment decisions.
Clinical & Coding Specifications
Clinical Context
A patient with a newly diagnosed malignant neoplasm of the gastrointestinal tract, such as the rectum, small intestine, or appendix, is referred for advanced molecular testing. The treating oncologist requests a comprehensive genomic sequence analysis panel to identify sequence variants in the tumor tissue. The specimen is sent to a CLIA-certified diagnostic laboratory, where a pathologist oversees the genomic sequencing procedure. The results help guide targeted therapy decisions and inform prognosis. The workflow involves specimen collection, laboratory processing, genomic sequencing, and interpretation by a pathology or oncology specialist.
Coding Specifications
-
Modifier
26: Used when reporting only the professional component of the service, such as interpretation of the genomic sequencing results by a physician. -
Modifier
TC: Used when reporting only the technical component, which includes laboratory processing and sequencing.
| Modifier Code | Description |
|---|---|
26 | Professional Component |
TC | Technical Component |
-
Provider Taxonomies:
207ZP0102X- Pathology Physician207L00000X- Anatomic Pathology & Clinical Pathology Physician207RI0200X- Medical Oncology Physician
These specialties are typically involved in ordering, performing, and interpreting genomic sequencing for solid organ neoplasms.
Related Diagnoses
-
C17.0‑C17.9- Malignant neoplasm of duodenum ‑ Malignant neoplasm of small intestine, unspecified- Relevant for patients with tumors in the duodenum or small intestine undergoing genomic sequencing.
-
C18.0‑C19- Malignant neoplasm of cecum ‑ Malignant neoplasm of rectosigmoid junction- Applies to colorectal cancer cases where genomic analysis may guide therapy.
-
C20- Malignant neoplasm of rectum- Used for rectal cancer patients needing molecular profiling.
-
C21.1- Malignant neoplasm of anal canal- Relevant for anal canal tumors evaluated by genomic sequencing.
-
C21.2- Malignant neoplasm of cloacogenic zone- Applies to rare tumors in the cloacogenic zone.
-
C21.8- Malignant neoplasm of overlapping sites of rectum, anus and anal canal- Used when tumors span multiple adjacent sites.
-
C7A.020‑C7A.026- Malignant carcinoid tumor of the appendix ‑ Malignant carcinoid tumor of the rectum- Relevant for carcinoid tumors in the appendix or rectum, where genomic analysis may inform management.
Related CPT Codes
-
81445- Targeted genomic sequence analysis panel (DNA‑based panels) for solid organ neoplasm testing- Used for smaller, targeted panels; may be ordered when fewer genes are needed.
-
81450- Targeted genomic sequence analysis panel (DNA‑based) for hematolymphoid neoplasm, 5‑50 genes- Used for hematolymphoid neoplasms; not typically used for solid organ tumors.
-
81449- RNA‑based targeted testing panel- Used for RNA-based analysis; may complement DNA-based testing.
-
81451- RNA‑based targeted testing panel- Similar to
81449; used for RNA analysis in neoplasms.
- Similar to
-
81455- Solid organ or hematolymphoid neoplasm genomic sequence analysis panel, ≥51 genes, interrogation for sequence variants and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed- Used for larger panels; may be ordered when comprehensive analysis is needed.
-
81456- Similar to81455(≥51 genes panel) with RNA component- Used when both DNA and RNA analysis are required.
-
81458- Solid organ neoplasm genomic sequence analysis panel, interrogation for sequence variants with MSI and CNVs- Includes microsatellite instability (MSI) and copy number variants (CNVs); may be used for expanded testing.
-
81459- Comprehensive Genomic Profile (CGP) panel- Used for broad, comprehensive profiling; may be an alternative to
81457.
- Used for broad, comprehensive profiling; may be an alternative to
-
81479- Not Otherwise Classified (NOC) molecular pathology panel—used when CGP definition not met- Used when testing does not fit standard panel definitions.
These codes may be used as alternatives or in conjunction with 81457, depending on the clinical scenario and the extent of genomic analysis required.
National Reimbursement Benchmarks
National mean rates for CPT code 81457 among commercial payers show that UnitedHealth Group has the highest average reimbursement at $703.61, while Cigna is notably lower at $435.15. The BUCA average (Blue Cross Blue Shield, UnitedHealth Group, Cigna, Aetna) stands at $662.09. Medicare rates are not available in the input for comparison.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Cigna exhibits the widest spread at $604.57, indicating substantial variability in contracted rates. In contrast, Aetna has a tighter range of $265.75, suggesting more consistent reimbursement levels. Blue Cross Blue Shield and UnitedHealth Group also show considerable dispersion, with ranges of $350.80 and $385.50, respectively.
The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.
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.