2025 CPT code 81451
(Revised) Effective Date: N/A Revision Date: N/A Laboratory - Genomic Sequencing Procedures and Other Molecular Multianalyte Assays Pathology and Laboratory Procedures Feed
Genomic sequence analysis panel evaluating RNA alterations in 5-50 genes related to hematolymphoid cancers or disorders.
Modifiers may apply depending on the specific circumstances of the service.Consult the CPT manual and payer guidelines for appropriate modifier usage.
Medical necessity for CPT code 81451 is established by a physician's order based on the patient's clinical presentation, such as suspected hematolymphoid malignancy or assessment of treatment response.The test must be deemed necessary to guide treatment or inform prognosis.Payers may have additional requirements for medical necessity documentation.
The clinical responsibility lies with the laboratory performing the genomic sequencing and analysis. The ordering physician is responsible for ordering the appropriate test based on the patient's clinical presentation and for interpreting the results in the context of the patient's overall medical history and condition.
- Pathology and Laboratory Procedures
- Genomic Sequencing Procedures and Other Molecular Multianalyte Assays
In simple words: This lab test analyzes RNA from a blood or bone marrow sample to look for changes in 5 to 50 genes linked to blood or lymph cancers.It helps doctors understand the cancer's genetics and plan the best treatment.
This CPT code represents a genomic sequence analysis panel designed to evaluate RNA alterations within 5 to 50 genes known to be associated with hematolymphoid cancers or disorders.The procedure involves extracting RNA from a patient specimen (e.g., blood or bone marrow aspirate), amplifying target RNA sequences (e.g., using reverse transcription polymerase chain reaction), and analyzing the sequences using methods such as next-generation sequencing (NGS). Analysis may include the identification of sequence variants and rearrangements, focusing on RNA to assess the impact of gene expression and isoform expression on disease development and progression.The results help characterize genetic mutations and expression patterns involved in hematolymphoid diseases and inform treatment decisions.
Example 1: A patient presents with suspected acute lymphoblastic leukemia (ALL). A bone marrow aspirate is sent to the laboratory for genomic sequencing using CPT code 81451 to identify RNA alterations in relevant genes to guide treatment decisions., A patient with a history of chronic lymphocytic leukemia (CLL) experiences disease progression.A blood sample is tested using CPT code 81451 to analyze RNA expression levels of key genes, providing insights into treatment resistance and potential therapeutic options., A patient undergoes a bone marrow transplant for multiple myeloma.Post-transplant, a blood sample is tested using CPT code 81451 to monitor for minimal residual disease (MRD) by assessing RNA alterations in disease-specific genes.
* Patient demographics and relevant medical history.* Complete clinical indication for testing (suspected diagnosis, disease stage, treatment history).* Specimen type and collection date.* Detailed description of the genomic sequencing panel, including the specific genes analyzed.* Laboratory report detailing the results of the RNA analysis and interpretation of findings.
** This code is primarily used in the context of hematolymphoid neoplasms but may have applications in other hematologic disorders with relevant genetic alterations.Accurate coding requires careful review of the laboratory report and adherence to current coding guidelines.
- Payment Status: Active
- Modifier TC rule: Technical component (TC) modifiers may apply depending on the laboratory's procedures and billing practices.Refer to payer guidelines.
- Specialties:Hematology, Oncology, Pathology
- Place of Service:Laboratory, Hospital, Physician's Office