2025 CPT code 81202
(Active) Effective Date: N/A Revision Date: N/A Molecular Pathology - Genetic Analysis Procedures Pathology and Laboratory Procedures > Molecular Pathology Procedures Feed
Analysis of known familial variants in the adenomatous polyposis coli (APC) gene.
Modifiers may be applicable depending on the circumstances. Modifier 26 might be used if a physician interprets the results separately.
Medical necessity is typically established by a family history of FAP or attenuated FAP, or in cases where a patient presents with suggestive clinical findings and a family history of colorectal cancer.The test helps in risk assessment and preventative management of colorectal cancer.
The clinical responsibility lies with the laboratory analyst who performs the technical aspects of the test. A physician may separately interpret the results (G0452 with modifier 26).
- Pathology and Laboratory Procedures > Molecular Pathology Procedures
- Tier 1 Molecular Pathology Procedures
In simple words: This lab test checks for specific gene changes (mutations) in the APC gene that run in a patient's family. It helps find out if they have an increased risk of certain types of colon cancer.
This CPT code encompasses the laboratory analysis of known familial variants within the adenomatous polyposis coli (APC) gene.The procedure includes all analytical steps, from nucleic acid extraction (e.g., cell lysis, digestion) and amplification to detection of target gene variants.This test focuses on previously identified mutations within a patient's family history, not a full gene sequence or duplication/deletion analysis.
Example 1: A patient with a family history of familial adenomatous polyposis (FAP) undergoes this test to determine if they carry a known familial APC gene mutation. , A patient presents with multiple colon polyps and a family history suggestive of attenuated FAP. This test helps to identify if the patient carries a known familial APC variant associated with this condition., As part of a comprehensive cancer risk assessment, this test is performed on a patient with a strong family history of colorectal cancer to assess the presence of specific APC gene mutations previously identified within their family.
* Patient's family history of colorectal cancer or FAP.* Detailed pedigree chart documenting affected family members and their mutations.* Documentation of the specific APC gene variants being tested.* Lab reports detailing the methodology and results of the test.
** This test is considered medically necessary in certain cases for at-risk individuals or those with a confirmed diagnosis of FAP or attenuated FAP. However, coverage may vary between payers.Always refer to individual payer guidelines for definitive coverage determination.
- Payment Status: Active
- Specialties:Gastroenterology, Medical Genetics, Oncology
- Place of Service:Office, Hospital outpatient, Clinical laboratory