2025 CPT code 81457
Genomic sequence analysis panel for solid organ neoplasm; DNA analysis for sequence variants and microsatellite instability (MSI).
Modifiers may be applicable depending on the circumstances of the service.Refer to CPT guidelines for specific modifier usage.
Medical necessity is established when there is clinical suspicion for a solid organ neoplasm requiring detailed genetic analysis to inform diagnosis, prognosis, and treatment planning.The information provided by 81457 helps guide decisions regarding targeted therapies, immunotherapy, and other treatment strategies.Payers may have specific criteria for approving this test, often based on the type of cancer and clinical context.
A pathologist or clinical laboratory scientist is responsible for performing this test and interpreting results. This involves specimen processing, nucleic acid extraction, amplification, sequencing, bioinformatic analysis, and report generation. The ordering physician is responsible for appropriate test selection, medical necessity, and integration of results into the patient's care.
In simple words: This lab test analyzes a tumor sample to find specific changes in the DNA that are linked to solid organ cancers.It also checks for microsatellite instability (MSI), which shows how likely the cancer cells are to change and helps doctors decide on the best treatment.
This CPT code, 81457, reports a genomic sequence analysis panel used to evaluate a solid organ neoplasm specimen.The analysis specifically targets DNA sequence variants and microsatellite instability (MSI).The procedure involves extracting DNA from the specimen, amplifying target sequences (e.g., using PCR), and employing massively parallel sequencing (MPS) or other appropriate technologies to determine the order of nucleotides. Bioinformatics analysis then compares the findings to known genetic changes associated with solid organ neoplasms.The test identifies sequence variants (substitutions, insertions, deletions) and assesses MSI, a marker of DNA replication errors that may influence cancer development and treatment strategies.
Example 1: A patient presents with a suspicious lung mass.A biopsy is performed, and the tissue is sent for genomic sequencing using code 81457 to identify potential driver mutations and MSI status to guide treatment decisions (e.g., targeted therapy, immunotherapy)., A patient with a history of colorectal cancer undergoes a follow-up colonoscopy.A suspicious polyp is resected and sent for testing with 81457 to detect recurrence or identify additional genetic alterations that may be contributing to disease progression., A patient with metastatic melanoma receives genomic sequencing using 81457 on a metastatic lesion to determine tumor heterogeneity and MSI status, potentially informing immunotherapy or targeted therapy strategies.
* Patient demographics and relevant medical history.* Detailed information about the neoplasm (location, size, type, stage).* Pathology report confirming the diagnosis of a solid organ neoplasm.* Specimen type (e.g., tissue biopsy, fine needle aspirate, cytology).* Method used for nucleic acid extraction and amplification.* Sequencing platform and analysis methods used.* Complete lab report with detailed analysis of sequence variants and MSI status.
** The interpretation of results from code 81457 requires expertise in molecular pathology and oncology.Clinical correlation with other diagnostic and clinical data is essential for appropriate patient management.This test is not appropriate for all solid organ neoplasms; medical necessity should be established prior to ordering the test.
- Revenue Code: T1G (LAB TESTS - OTHER)
- Payment Status: Active
- Modifier TC rule: TC modifier may not be applicable as this is a comprehensive panel.
- Specialties:Oncology, Pathology, Medical Genetics
- Place of Service:Office, Hospital (Inpatient and Outpatient), Ambulatory Surgery Center, Hospital Outpatient Department