2025 CPT code 81463
Genomic sequence analysis panel of cell-free DNA (cfDNA) in plasma, evaluating sequence variants, copy number variants, and microsatellite instability (MSI) for solid organ neoplasms.
Modifiers may apply depending on the specific circumstances of the test performance.Consult CPT guidelines and payer policies for appropriate modifier use.
Medical necessity for 81463 is established based on the clinical suspicion of a solid organ neoplasm, the need for early detection, treatment guidance, monitoring of residual disease, or assessment of treatment resistance. This requires supporting documentation, such as imaging studies or pathology reports.
Laboratory personnel are responsible for specimen processing, nucleic acid extraction, amplification (if necessary), sequencing, bioinformatic analysis, and result reporting. Clinicians interpret the results in the context of patient care and treatment decisions.
- Pathology and Laboratory Procedures > Genomic Sequencing Procedures and Other Molecular Multianalyte Assays
- 81462-81464
In simple words: This blood test (liquid biopsy) checks for genetic changes in DNA fragments from tumor cells circulating in the blood.It helps doctors diagnose and treat solid organ cancers by identifying specific mutations and instability in the tumor's DNA.
This CPT code, 81463, represents a genomic sequence analysis panel performed on a cell-free nucleic acid (eg, plasma) specimen to detect sequence variants, copy number variants, and microsatellite instability (MSI) in the context of solid organ neoplasms.The analysis uses techniques like next-generation sequencing (NGS) to identify these alterations within circulating DNA fragments. This test is often referred to as a liquid biopsy and aids in diagnosis and treatment strategies for solid organ tumors.
Example 1: A patient presents with suspected lung cancer. A liquid biopsy (81463) is ordered to detect early cancer-related mutations, guiding treatment decisions before invasive tissue biopsy., Post-surgical resection of a colon tumor, a liquid biopsy (81463) monitors for residual disease or recurrence by detecting circulating tumor DNA, assisting in targeted therapy and monitoring of disease response., A patient with metastatic melanoma has progressed on targeted therapy. A liquid biopsy (81463) assesses for the emergence of new mutations that could explain resistance, informing subsequent treatment approaches.
* Patient demographics and medical history.* Indication for testing (clinical suspicion, disease monitoring).* Specimen collection details (date, time, method).* Complete lab report, including details on sequencing technology, variants detected, copy number changes, MSI status, and bioinformatic analysis.
** This code is part of a family of codes (81462-81464) that describe genomic sequence analysis panels for solid organ or hematolymphoid neoplasms using cell-free DNA or a combination of DNA and RNA.The choice of specific code depends on the analyses performed (MSI, TMB).
- Revenue Code: T1G (LAB TESTS - OTHER)
- Payment Status: Active
- Specialties:Oncology, Pathology, Medical Oncology
- Place of Service:Laboratory