Summary & Overview
CPT 81473: Targeted Genomic Sequence Analysis Panel for Solid Organ Neoplasms
CPT code 81473 represents a targeted genomic sequence analysis panel for solid organ neoplasms, involving DNA analysis of 5 to 50 genes. This advanced laboratory procedure is pivotal in oncology, offering precise genetic insights that inform diagnosis, prognosis, and treatment planning for patients with cancers such as lung, breast, colon, prostate, and pancreatic neoplasms. The code is primarily utilized in independent laboratory settings, reflecting the growing role of molecular diagnostics in cancer care.
Blue Cross Blue Shield is a key payer covered in this analysis, highlighting the importance of understanding payer policies and coverage for molecular pathology services. Readers will gain insights into national benchmarks, policy updates, and the clinical context surrounding the use of 81473. The publication also addresses relevant modifiers, associated taxonomies, and related CPT codes, providing a comprehensive overview for stakeholders in pathology, laboratory medicine, and family medicine.
This summary equips healthcare professionals, administrators, and policy analysts with essential information on the utilization, coverage, and clinical significance of targeted genomic sequencing in solid organ neoplasms, supporting informed decision-making in the evolving landscape of precision medicine.
CPT Code Overview
CPT code 81473 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 malignancy, such as lung, breast, colon, prostate, or pancreatic cancer, is referred for advanced molecular testing. The treating oncologist requests a targeted genomic sequence analysis panel to identify mutations in 5-50 genes relevant to the neoplasm. The specimen, typically a tissue biopsy from the affected organ, is sent to an independent laboratory (Place of Service 81). A pathologist specializing in molecular genetic pathology oversees the DNA analysis, which informs prognosis and potential targeted therapies. Results are integrated into the patient's oncology care plan.
Coding Specifications
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Modifiers:
- Modifier
26: Used when reporting only the professional component of the laboratory service, such as interpretation of results by a pathologist. - Modifier
59: Indicates a distinct procedural service, used when the genomic panel is performed separately from other procedures.
- Modifier
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207ZP0102X | Pathology - Clinical Pathology/Laboratory Medicine |
207ZP0007X | Pathology - Molecular Genetic Pathology |
207Q00000X | Family Medicine Physician |
- Specialties Represented:
- Clinical Pathology/Laboratory Medicine: Laboratory-based diagnostic services.
- Molecular Genetic Pathology: Specialized molecular testing and interpretation.
- Family Medicine Physician: May order or coordinate testing as part of comprehensive care.
Related Diagnoses
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C34.90: Malignant neoplasm of unspecified part of unspecified bronchus or lung- Relevant for patients with lung cancer undergoing genomic analysis to guide targeted therapy.
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C50.919: Malignant neoplasm of unspecified site of unspecified female breast- Used for breast cancer cases where molecular profiling informs treatment decisions.
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C18.9: Malignant neoplasm of colon, unspecified- Applied to colon cancer patients for identifying actionable genetic mutations.
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C61: Malignant neoplasm of prostate- Pertinent for prostate cancer, where genomic testing may influence management.
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C25.9: Malignant neoplasm of pancreas, unspecified- Used for pancreatic cancer to detect genetic alterations relevant to therapy selection.
Related CPT Codes
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81445: Targeted genomic sequence analysis panel, solid organ neoplasm, DNA analysis, 5-50 genes.- Closely related to
81473, often used for similar testing panels. May be used as an alternative depending on panel specifics.
- Closely related to
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81479: Unlisted molecular pathology procedure.- Used when a molecular pathology service does not have a specific CPT code. May be used if the genomic panel falls outside the defined parameters of
81473.
- Used when a molecular pathology service does not have a specific CPT code. May be used if the genomic panel falls outside the defined parameters of
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88342: Immunohistochemistry, per specimen; initial single antibody stain procedure.- Commonly performed alongside genomic testing to assess protein expression in tumor tissue.
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88341: Immunohistochemistry, per specimen; each additional single antibody stain procedure.- Used in conjunction with
88342for further immunohistochemical analysis. Often ordered together in comprehensive tumor profiling.
- Used in conjunction with
National Reimbursement Benchmarks
National mean rates for CPT code 81473 are identical between Blue Cross Blue Shield and BUCA (average commercial), both at $80.02. Medicare rates are not available in the input 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 indicates a very tight range, with no variation between the lower and upper quartiles for these payers.
The table and chart below present the full breakdown of national benchmarks for CPT code 81473 by payer.
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