2025 CPT code 81236

Analysis of the entire EZH2 gene sequence.

Follow CPT guidelines for molecular pathology procedures.Modifiers may apply depending on the services rendered.

Modifier 26 may be added if only interpretation and report are performed, and modifier 99 might be appropriate for multiple procedures.

Medical necessity for this test is established when the ordering physician has clinical suspicion of a condition for which EZH2 mutations are clinically relevant (e.g., certain hematologic malignancies) and the results are expected to influence management decisions.

The clinical responsibility lies with the laboratory analyst who performs the technical aspects of the test. A physician or other qualified healthcare professional may separately interpret the results.

IMPORTANT Code 81237 (EZH2 common variant analysis) should not be confused with this code.If only interpretation of the results is performed, modifier 26 may be appended.

In simple words: This lab test analyzes the complete genetic instructions for making a specific protein (EZH2) involved in cell growth and development. It helps doctors understand certain types of blood cancers.

This CPT code encompasses the comprehensive analysis of the entire coding sequence of the enhancer of zeste 2 polycomb repressive complex 2 subunit gene (EZH2).The procedure includes all analytical steps, from nucleic acid extraction (e.g., cell lysis, digestion) and amplification (e.g., polymerase chain reaction, PCR) to the detection of the target gene. Results may require interpretation by a qualified healthcare professional (modifier 26 may be added if interpretation is billed separately).

Example 1: A patient presents with symptoms suggestive of myelodysplastic syndrome.The physician orders this test to assess for potential EZH2 mutations that may contribute to the diagnosis and guide treatment decisions., A patient with a history of myeloproliferative neoplasm undergoes this genetic testing as part of routine monitoring and risk stratification for disease progression., Following a diagnosis of a specific type of cancer, this test is used to determine the presence of EZH2 mutations to predict treatment response or prognosis and select targeted therapies.

* Patient demographics and relevant medical history.* Indication for the test (e.g., suspected myelodysplastic syndrome, myeloproliferative neoplasm, cancer).* Specimen type (e.g., blood, bone marrow, tissue).* Detailed laboratory report, including the sequencing methodology and identification of any mutations.* Physician’s interpretation report if billed separately.

** The specific methodology used for the EZH2 gene analysis (e.g., next-generation sequencing, PCR) is not explicitly specified in the code itself.The comprehensive analysis includes detection of all variants within the tested sequence but may not encompass every possible variant.

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