Summary & Overview
CPT 81462: Genomic Sequence Analysis Panel for Solid Organ Neoplasms
CPT code 81462 represents a genomic sequence analysis panel for solid organ neoplasms, utilizing cell-free nucleic acids to detect sequence variants, copy number changes, and rearrangements. This advanced molecular assay is pivotal in oncology, offering clinicians critical insights into tumor genetics and guiding personalized treatment strategies. The procedure is typically performed in laboratory settings and is part of the broader category of genomic sequencing and multianalyte assays.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, provide coverage for this code, reflecting its clinical importance and widespread adoption. Readers will gain an understanding of payer coverage benchmarks, recent policy updates, and the clinical context surrounding the use of 81462. The publication also explores related codes, common billing modifiers, and associated medical genetics taxonomies, offering a comprehensive overview for stakeholders in laboratory medicine, oncology, and medical genetics.
This summary provides a national perspective on the utilization and reimbursement landscape for 81462, equipping readers with essential information for navigating genomic testing in solid organ neoplasms.
CPT Code Overview
CPT code 81462 is used for genomic sequence analysis panels targeting solid organ neoplasms. This procedure analyzes cell-free nucleic acids, such as plasma, to interrogate for sequence variants, copy number variants, and rearrangements. It is classified under Genomic Sequencing Procedures and Other Molecular Multianalyte Assays. The typical site of service for this test is a laboratory setting (POS 81). This code is essential for advanced molecular diagnostics in oncology, enabling precise detection of genetic alterations in solid organ tumors.
Clinical & Coding Specifications
Clinical Context
A patient with a suspected or confirmed solid organ neoplasm, such as breast or ovarian cancer, presents to their oncologist. The clinician orders a genomic sequence analysis panel using cell-free nucleic acid from plasma to interrogate for sequence variants, copy number variants, and rearrangements. The test is performed in a laboratory setting (Place of Service 81) and is used to guide diagnosis, prognosis, or treatment decisions based on the molecular profile of the tumor. The workflow typically involves specimen collection, laboratory analysis, and interpretation by a medical genetics specialist.
Coding Specifications
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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 the laboratory processing and analysis of the specimen. -
Modifier
59: Used to indicate a distinct procedural service, typically when multiple procedures are performed that are not normally reported together.
| Modifier Code | Description |
|---|---|
26 | Professional Component |
TC | Technical Component |
59 | Distinct Procedural Service |
Associated Provider Taxonomies:
207SG0201X– Medical Genetics, Clinical Genetics (M.D.)207SG0202X– Medical Genetics, Clinical Biochemical Genetics207SG0203X– Medical Genetics, Clinical Cytogenetics207SG0205X– Medical Genetics, Clinical Molecular Genetics
These specialties represent physicians and geneticists with expertise in interpreting and managing genomic sequencing results for solid organ neoplasms.
Related Diagnoses
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C50.A1– Data not available in the input.- This code is associated with solid organ neoplasms, likely breast cancer, and is relevant for genomic sequencing to identify actionable mutations.
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C50.A2– Data not available in the input.- This code is also related to solid organ neoplasms, possibly a different subtype or location within breast cancer, and is used for molecular profiling.
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C56.3– Data not available in the input.- This code is associated with ovarian cancer and is clinically relevant for genomic sequencing to guide treatment and prognosis.
Each diagnosis code is relevant to the use of 81462 for identifying genetic variants in patients with solid organ neoplasms.
Related CPT Codes
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81479– Unlisted molecular pathology procedure- Used for molecular pathology procedures not otherwise specified; may be used when a unique or uncommon test is performed.
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81228– Cytogenomic constitutional (genome-wide) microarray analysis- Used for genome-wide microarray analysis, typically for constitutional (non-tumor) genetic testing; may be performed in parallel with or as an alternative to
81462.
- Used for genome-wide microarray analysis, typically for constitutional (non-tumor) genetic testing; may be performed in parallel with or as an alternative to
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81229– Cytogenomic constitutional (genome-wide) microarray analysis; each additional microarray- Used when more than one microarray is performed; can be reported alongside
81228.
- Used when more than one microarray is performed; can be reported alongside
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81460– Whole mitochondrial genome sequence analysis- Used for sequencing the entire mitochondrial genome; may be relevant in cases where mitochondrial mutations are suspected.
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81465– Whole exome sequence analysis- Used for sequencing the entire exome; may be considered as an alternative or complementary test to
81462depending on clinical indications.
- Used for sequencing the entire exome; may be considered as an alternative or complementary test to
These codes may be used together or as alternatives depending on the clinical scenario and the specific molecular information required.
National Reimbursement Benchmarks
For CPT code 81462, the national mean rate for BUCA (average commercial) payers is $865.68, which is substantially higher than typical Medicare rates (Medicare data not available in the input). Among individual commercial payers, UnitedHealth Group has the highest mean rate at $945.34, while Cigna is notably lower at $571.18.
Rate dispersion varies significantly across payers. Blue Cross Blue Shield shows the widest spread, with a difference of $869.50 between its 75th and 25th percentiles, indicating substantial variability in contracted rates. In contrast, Aetna's range is tighter at $354.25, suggesting more consistent reimbursement levels. Cigna also exhibits a wide range, with a $822.67 difference between its 75th and 25th percentiles.
The table and chart below present a detailed breakdown of national mean rates and percentile distributions 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.