2025 CPT code 81479
(Active) Effective Date: N/A Pathology and Laboratory - Molecular Pathology Procedures Feed
Unlisted molecular pathology procedure.
Modifier 26 can be appended if only the professional component (interpretation and report) of the test was performed. Other modifiers may be applicable depending on the specific circumstances of the procedure.
Medical necessity must be clearly documented. The documentation must support the rationale for performing the unlisted molecular pathology procedure and why an existing code is not applicable.
The laboratory analyst performs the unlisted molecular pathology procedure and provides an interpretation and report.
In simple words: This code is used when a doctor performs a genetic test on a sample of your cells (like blood or tissue) to look for changes in your genes that could be causing a health problem, and there isn't a specific code for that particular test.
This code is used to report molecular pathology procedures that are not described by any other specific CPT code. Molecular pathology procedures involve the analysis of nucleic acid (DNA, RNA) to detect gene variants indicative of germline or somatic conditions, or to test for histocompatibility antigens.
Example 1: A patient presents with symptoms suggestive of a rare genetic disorder for which no specific molecular pathology test is available. An unlisted molecular pathology procedure is performed to analyze the patient's DNA for potential causative variants., A patient with cancer undergoes tumor profiling to identify specific genetic mutations that may guide treatment decisions. If the specific gene panel tested is not represented by an existing CPT code, 81479 would be reported., A research study requires a novel molecular pathology test to be performed on patient samples. As this is a new procedure not yet represented in the CPT code set, code 81479 is used for reporting.
Detailed documentation of the procedure performed, including the specific analyte(s) tested, methodology used, and interpretation of results. A cover letter explaining the medical necessity for the procedure and why no other existing CPT code is appropriate should also be included.
** When reporting 81479, it is essential to provide comprehensive documentation, including a detailed description of the procedure, methodology, and interpretation, to support the medical necessity of the test and justify the billed amount.
- Specialties:Pathology, Genetics, Oncology, and any specialty requiring specialized molecular diagnostic testing.
- Place of Service:Independent Laboratory, Hospital Outpatient, and other places where molecular pathology testing is performed.