Summary & Overview
CPT 81458: Genomic Sequence Analysis Panel for Solid Organ Neoplasms
CPT code 81458 represents a genomic sequence analysis panel for solid organ neoplasms, focusing on DNA sequence variants, copy number variants, and microsatellite instability. This advanced molecular assay is pivotal in oncology, enabling detailed tumor profiling that supports personalized cancer treatment strategies. The code is widely recognized and utilized in laboratory settings, reflecting the growing importance of precision medicine in cancer care.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, provide coverage for this procedure, underscoring its clinical relevance and adoption across the healthcare landscape. Readers will gain insights into payer coverage, clinical indications, and the role of 81458 in modern oncology diagnostics. The publication also addresses related policy updates, benchmarks, and the broader context of genomic sequencing procedures in cancer management.
This summary offers a comprehensive overview of the clinical and billing landscape for CPT code 81458, equipping stakeholders with essential information on payer policies, laboratory practices, and the evolving standards in molecular pathology for solid tumors.
CPT Code Overview
CPT code 81458 is used for genomic sequence analysis panels targeting solid organ neoplasms. This procedure involves interrogation for sequence variants, including DNA analysis, copy number variants, and microsatellite instability. It is classified under Genomic Sequencing Procedures and Other Molecular Multianalyte Assays, specifically for oncology solid tumor panels. The typical site of service for this test is a laboratory setting (POS 81). This code is integral for comprehensive molecular profiling of solid tumors, supporting precision oncology and informing treatment decisions.
Clinical & Coding Specifications
Clinical Context
A patient with a suspected or confirmed malignant neoplasm of the gastrointestinal tract, such as the duodenum, small intestine, colon, rectum, or anal canal, is referred for advanced genomic testing. The ordering physician, often a specialist in oncology, pathology, or medical genetics, requests a solid organ neoplasm genomic sequence analysis panel to interrogate for sequence variants, copy number variants, and microsatellite instability. The specimen is sent to a laboratory (Place of Service 81), where the test is performed. Results are interpreted by a qualified provider, such as a medical geneticist or molecular pathologist, to inform diagnosis, prognosis, or targeted therapy options.
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:
| Taxonomy Code | Specialty Name |
|---|---|
207SG0201X | Medical Genetics, Ph.D. Medical Genetics |
207ZP0213X | Pathology, Molecular Genetic Pathology |
207Q00000X | Family Medicine Physician |
207R00000X | Internal Medicine Physician |
207RI0200X | Internal Medicine, Clinical & Laboratory Immunology |
These specialties represent providers who may order, perform, or interpret the genomic sequencing procedure.
Related Diagnoses
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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, where genomic analysis can guide treatment.
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C18.0-C19: Malignant neoplasm of cecum – Malignant neoplasm of rectosigmoid junction- Applies to colorectal cancers, which are commonly evaluated for sequence variants and microsatellite instability.
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C20: Malignant neoplasm of rectum- Indicates rectal cancer, where genomic sequencing may inform targeted therapy.
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C21.1: Malignant neoplasm of anal canal- Used for anal canal tumors, which may require molecular profiling.
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C21.2: Malignant neoplasm of cloacogenic zone- Pertains to tumors in the cloacogenic zone, relevant for genomic analysis.
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C21.8: Malignant neoplasm of overlapping sites of rectum, anus and anal canal- For cases involving multiple sites, genomic sequencing helps in comprehensive assessment.
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C7A.020-C7A.026: Malignant carcinoid tumor of the appendix – Malignant carcinoid tumor of the rectum- Applies to carcinoid tumors, where molecular testing can assist in diagnosis and management.
Related CPT Codes
81445: Data not available in the input.81449: Data not available in the input.81457: Data not available in the input.81462: Data not available in the input.81463: Data not available in the input.81459: Data not available in the input.81464: Data not available in the input.
These CPT codes are related to genomic sequencing procedures and molecular multianalyte assays. They may represent alternative panels, additional testing options, or complementary procedures in the clinical workflow for oncology solid tumor panels. Codes may be used together or as alternatives depending on the specific clinical scenario and testing requirements.
National Reimbursement Benchmarks
National mean rates for CPT code 81458 show that BUCA (average commercial) payers reimburse at $761.70, while UnitedHealth Group offers the highest mean rate among individual commercial payers at $824.30. Cigna's mean rate is notably lower at $507.65. Medicare data is 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 ($713.63), indicating substantial variability in reimbursement, while Aetna has a tighter range ($309.75). Blue Cross Blue Shield and UnitedHealth Group also show considerable dispersion, with ranges of $546.36 and $476.25, respectively. 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.