2025 CPT code 81456
(Revised) Effective Date: N/A Revision Date: N/A Laboratory - Genomic Sequencing Procedures Pathology and Laboratory Procedures > Genomic Sequencing Procedures and Other Molecular Multianalyte Assays Feed
Genomic sequence analysis panel evaluating RNA alterations in 51 or more genes related to solid organ or hematolymphoid cancers.
Modifiers may be applicable to this code depending on the specific circumstances of service. Consult payer-specific guidelines.
Medical necessity for 81456 requires the presence of a solid organ or hematolymphoid neoplasm, for which the information provided by this comprehensive RNA genomic sequencing panel is necessary to guide treatment.The specific genes sequenced must be relevant to the diagnosis and management of the patient's condition, and the test should be ordered by a qualified physician based on the patient's individual clinical circumstances.
The clinical responsibility lies with the laboratory performing the genomic sequencing. The ordering physician is responsible for medical necessity and appropriate test selection based on patient clinical presentation.
- Pathology and Laboratory Procedures > Genomic Sequencing Procedures and Other Molecular Multianalyte Assays
- 81455 (parent code)
In simple words: This lab test analyzes RNA from a tumor sample (like from a biopsy) to check for changes in 51 or more genes linked to cancer. This helps doctors understand the cancer and plan the best treatment.
This CPT code, 81456, represents a genomic sequence analysis panel designed to assess RNA alterations across 51 or more genes significantly associated with solid organ or hematolymphoid neoplasms (cancers).The analysis uses techniques such as next-generation sequencing (NGS) to identify sequence variants and rearrangements within the RNA. The results help characterize the genetic mutations and expression levels impacting disease progression, guiding treatment decisions.
Example 1: A patient with suspected lymphoma undergoes a bone marrow biopsy.The sample is sent for genomic sequencing using CPT code 81456 to identify RNA alterations in a panel of genes associated with lymphomagenesis., A patient with a solid tumor undergoes surgical resection, and tumor tissue is sent for comprehensive genomic profiling, including RNA sequencing using CPT code 81456, to inform treatment decisions. This could include the evaluation of resistance mechanisms, potential targeted therapy options, and prognosis., A patient with a history of leukemia relapse has peripheral blood collected for liquid biopsy.RNA sequencing (81456) is ordered to detect minimal residual disease and monitor treatment response.
* Patient demographics and medical history including details of the suspected neoplasm.* Detailed description of the specimen type and source.* Report from the testing laboratory including the list of genes analyzed, the methods used, and detailed results.* Indication for the testing that demonstrates medical necessity.
** This code is part of a family of codes (81445-81464) designed to report genomic sequencing of neoplasms. Accurate code selection depends on the specimen source (solid organ, hematolymphoid, cell-free), nucleic acid type (DNA, RNA, or both), and types of alterations assessed (sequence variants, copy number variants, microsatellite instability, tumor mutation burden, rearrangements).
- Payment Status: Active
- Modifier TC rule: A Technical Component (TC) modifier may apply, depending on the specific arrangement and billing practices between the ordering physician and the laboratory. Review payer-specific policies.
- Specialties:Oncology, Hematology, Pathology
- Place of Service:Office, Hospital (Inpatient/Outpatient), Ambulatory Surgical Center, Laboratory