2025 CPT code 81455
(Revised) Effective Date: N/A Revision Date: N/A Pathology and Laboratory Procedures - Genomic Sequencing Procedures and Other Molecular Multianalyte Assays Feed
Genomic sequence analysis panel for solid organ or hematolymphoid neoplasms, evaluating 51 or more genes for DNA and possibly RNA alterations.
Medical necessity is established when the test results will directly impact treatment decisions, such as selecting targeted therapies or determining prognosis, in a way that has a tangible patient impact.The use of the test may also be considered medically necessary to exclude the use of ineffective targeted therapies when supported by medical literature.
The laboratory analyst performs the genomic sequence analysis panel on a patient specimen to evaluate DNA and possibly RNA alterations in genes related to solid organ cancers or hematolymphoid disorders or cancers.This involves processing the specimen, extracting nucleic acids, amplifying the target DNA and possibly RNA, and evaluating the nucleic acids, typically using next-generation sequencing (NGS) and bioinformatics.
In simple words: This test analyzes a patient's tumor tissue or bone marrow to look for changes in 51 or more genes that are associated with cancer. It helps doctors understand the specific genetic changes driving the cancer and determine the best treatment.
Targeted genomic sequence analysis panel for solid organ or hematolymphoid neoplasm or disorder, analyzing 51 or more genes, including interrogation for sequence variants, copy number variants, rearrangements, isoform expression, or mRNA expression levels when performed; includes DNA analysis or combined DNA and RNA analysis.
Example 1: A patient with a newly diagnosed solid organ tumor undergoes testing to identify potential targeted therapies., A patient with a hematolymphoid disorder undergoes testing to characterize the genetic mutations involved and guide treatment decisions., A patient with relapsed or refractory cancer undergoes testing to identify potential mechanisms of resistance and explore alternative treatment options.
Documentation should include the patient's clinical diagnosis, current condition, medical treatment history, previous pertinent medical treatments, and all current lab tests that support the medical necessity of the genomic sequencing procedure.A statement of how the test results will directly alter the treatment and/or medical management of the patient should also be included.
- Specialties:Oncology, Hematology, Pathology, Genetics
- Place of Service:Independent Laboratory, Outpatient Hospital, Inpatient Hospital