2025 CPT code 81464
Genomic sequence analysis panel evaluating cell-free nucleic acid (e.g., plasma) for sequence variants, copy number variants, rearrangements, microsatellite instability (MSI), and tumor mutation burden (TMB) in solid organ neoplasms.
Modifiers may be applicable depending on the specific circumstances of service. Consult CPT guidelines and payer specific requirements.
The medical necessity for 81464 is established when there is clinical suspicion of a solid organ neoplasm and the information obtained from the liquid biopsy is deemed necessary to guide treatment decisions. The test may be medically necessary for diagnosis, prognosis, treatment selection, monitoring, or minimal invasive assessment of disease progression.
Clinical laboratories perform this test. Ordering physicians interpret the results in the context of patient history, clinical findings, and other diagnostic information to guide treatment decisions.
In simple words: This lab test analyzes a blood sample (plasma) to look for genetic changes in cancer cells from solid organ tumors. It checks for various types of mutations and other changes in the DNA that can help doctors diagnose and treat cancer.This is sometimes called a "liquid biopsy."
This CPT code (81464) encompasses a genomic sequence analysis panel performed on a cell-free nucleic acid sample (e.g., plasma) from a patient with a suspected solid organ neoplasm.The analysis evaluates for sequence variants, copy number variants (CNVs), rearrangements, microsatellite instability (MSI), and tumor mutation burden (TMB). This comprehensive assessment aids in diagnosis and treatment strategy determination.The methodology typically involves massively parallel sequencing (MPS), such as next-generation sequencing (NGS), but other molecular techniques might be used. The reported results include detailed information about identified alterations and their clinical significance.
Example 1: A patient presents with suspicious imaging findings suggestive of lung cancer. A liquid biopsy (81464) is ordered to detect circulating tumor DNA (ctDNA) and identify potential mutations guiding treatment choices (e.g., targeted therapy or immunotherapy)., A patient with colorectal cancer undergoes a liquid biopsy (81464) before and after chemotherapy. The test monitors treatment response and detects the emergence of resistant mutations, enabling timely adjustments to the therapy regimen., A patient with metastatic melanoma has a liquid biopsy (81464) to assess tumor mutational burden (TMB) and microsatellite instability (MSI). This information is crucial to determine eligibility for immunotherapy and predict treatment success.
* Patient demographics and medical history including details of suspected neoplasm.* Indication for testing, including relevant clinical findings (imaging, physical exam, etc.).* Specimen collection and handling details (date, time, method).* Complete laboratory report including all identified variants, CNVs, rearrangements, MSI status, TMB, and interpretation of findings.* Any additional relevant clinical information, such as prior treatments.
** The results from this test should be interpreted by qualified healthcare professionals with expertise in molecular pathology and oncology. Results should be correlated with clinical findings and other diagnostic information.
- Revenue Code: T1G (LAB TESTS - OTHER)
- Payment Status: Active
- Modifier TC rule: Not applicable
- Specialties:Oncology, Pathology, Medical Oncology
- Place of Service:Hospital, Laboratory, Outpatient Center