2025 CPT code 81203

Analysis of the APC gene for duplication/deletion variants.

Refer to CPT guidelines for molecular pathology procedures.Proper documentation of the laboratory methods and results is crucial for accurate coding and reimbursement.

Modifier 26 may be appended if only the interpretation and report are performed by a physician.

Medical necessity is established by clinical suspicion of FAP or other conditions associated with APC gene copy number variations.This may be supported by a positive family history, presence of multiple colorectal polyps, or other relevant clinical findings.

The clinical responsibility lies with the laboratory analyst who performs the technical aspects of the test, including nucleic acid extraction, amplification, and detection. Physician interpretation of results may be separately reported using modifier 26.

IMPORTANT This code should be distinguished from 81201 (full APC gene sequencing) and 81202 (APC familial variants analysis).

In simple words: This lab test checks for changes in the number of copies of the APC gene.Too many or too few copies can be a sign of health problems.

This CPT code encompasses the technical component of analyzing the adenomatous polyposis coli (APC) gene for duplication/deletion variants.The procedure includes all analytical steps, from nucleic acid extraction (e.g., cell lysis, digestion) and amplification to detection of the target gene using methods such as nucleic acid probes. The analysis determines the copy number of specific gene sequences, identifying deletions (zero or one copy) or duplications (three or more copies) compared to the normal two-copy dosage.

Example 1: A patient presents with a family history of familial adenomatous polyposis (FAP) and multiple colorectal polyps.This test is ordered to assess for APC gene copy number variations, aiding in the diagnosis of FAP., A patient with a history of colorectal cancer undergoes genetic testing to identify potential predisposing factors. APC gene duplication/deletion analysis is performed to determine if copy number variations are present., A patient exhibits clinical features suggestive of attenuated FAP. The APC gene analysis is used to screen for subtle copy number changes, supporting the diagnosis.

** The analysis may not detect all types of genomic rearrangements (e.g., translocations, inversions).Refer to the laboratory report for detailed limitations of the test.

  • Revenue Code: Z2
  • RVU: unknown
  • Global Days : unknown
  • Payment Status: Active
  • Modifier TC rule: This code represents the technical component.A professional component (physician interpretation) may be separately reported with modifier 26.
  • Fee Schedule : unknown
  • Specialties:Medical Genetics, Gastroenterology, Oncology
  • Place of Service:Office, Hospital, Laboratory
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