2025 HCPCS code G0452
(Active) Effective Date: N/A Revision Date: N/A Professional Services - Molecular Pathology Interpretation Miscellaneous Services Feed
Physician interpretation and written report for a molecular pathology procedure.
Modifier 26 (Professional Component) is always required. Other modifiers may apply depending on the circumstances of the service, such as modifiers for place of service or multiple procedures. Check the NCCI edits for specific limitations.
The interpretation of the molecular pathology test must be medically necessary to justify the billing. This requires documentation that the results are needed to guide the patient's diagnosis or treatment and that the pathologist's written interpretation provides clinically significant information beyond the standard laboratory report.The interpretation should aid in decisions related to diagnosis, treatment planning, and prognosis.
The clinical responsibility lies with the physician specializing in molecular pathology.They must interpret the test results, exercise medical judgment, and create a comprehensive narrative report explaining the findings and their clinical significance. This report should integrate the lab results with the patient's clinical picture to provide additional medical context and support the diagnosis or treatment plan.
In simple words: This code pays a doctor for reviewing complex lab results from a special type of medical test (molecular pathology) and writing a detailed explanation for the patient's medical record. This explanation is beyond what the lab provides and is needed to help diagnose the patient's illness.Only doctors can bill for this.
This HCPCS code covers the professional service of interpreting and generating a written report for a molecular pathology procedure performed by a physician.The report must add medically necessary information beyond the standard laboratory results. This involves analyzing molecular data from cells or tissues to diagnose disease, particularly identifying disease-associated genes and chromosomal abnormalities.The interpretation requires medical judgment and must be documented in a narrative report within the patient's medical record.Only physician providers (not non-physician specialists) can bill for this service; modifier 26 (professional component) is always required.
Example 1: A patient presents with unexplained fatigue and anemia. A bone marrow biopsy reveals an abnormality suggestive of a rare blood disorder.Molecular pathology testing is ordered to identify the specific genetic mutation. The molecular pathologist uses G0452 to bill for interpreting the results and writing a report clarifying the genetic mutation's clinical significance, including implications for prognosis, treatment, and genetic counseling., A patient with a family history of colon cancer undergoes colonoscopy with biopsies. Molecular pathology analysis of the biopsy specimens reveals a genetic mutation increasing their risk for developing colon cancer. The molecular pathologist uses G0452 to bill for interpreting the genetic testing results and generating a report outlining the implications of this finding, including the need for increased surveillance or preventative measures. , A patient with a known tumor undergoes targeted molecular testing to assess the tumor's sensitivity to specific therapies. The molecular pathologist uses G0452 to bill for interpreting the complex results from these tests and writing a report outlining the optimal therapeutic strategies based on the tumor’s molecular profile.
* Patient's clinical history and relevant medical records.* Detailed laboratory report of the molecular pathology test.* Physician's order for the interpretation.* Complete narrative report by the molecular pathologist detailing their interpretation, including clinical correlation and justification for the conclusions.* Documentation demonstrating the medical necessity of the interpretation.
** The interpretation must be performed by a physician; non-physician providers cannot bill using this code.The medical necessity must be clearly documented to ensure reimbursement.Always refer to the most recent CMS guidelines and payer-specific requirements for accurate coding and billing.
- RVU: RVUs are not specified for this code. Reimbursement varies by payer and region. Consult your local Medicare Administrative Contractor (MAC) for specifics.
- Global Days: Not applicable. This is a professional service, not a procedure with a global period.
- Payment Status: Active
- Modifier TC rule: Modifier TC (Technical Component) does not apply to G0452, as this code solely addresses the physician's professional interpretation and reporting.
- Fee Schedule: Fee schedules vary by payer.Consult fee schedules specific to the payer and region.Historical fee data is not readily available for this code, but the CMS website or your payer's fee schedule database may provide relevant information.
- Specialties:Pathology, Medical Oncology, Hematology, Genetics
- Place of Service:Office, Hospital (Inpatient/Outpatient), Ambulatory Surgery Center, Clinical Laboratory