news article details

Correct Coding of Molecular Testing Panels (Revised)

The submission of claims using individual gene CPT codes, when gene panels are ordered, is considered incorrect coding. Correct coding requires that when a panel code is ordered, it should be billed, rather than the individual gene codes.

Effective 1/1/2024, DNA analysis or DNA and RNA analysis using a single combined method, are to be reported with code 81445,81450,81455, 81457, 81458, 81459, 81462, 81463 or 81464. RNA analysis performed using a separate method, is reported with code 81449, 81451 or 81456. When evaluation for TMB and/or MSI is performed as part of the same test for somatic alterations in neoplasms, report using code 81458 or 81459. When a GSP is performed on cell-free nucleic acid (eg, plasma), sometimes referred to as a liquid biopsy, report using code 81462, 81463 or 81464.

When a panel with greater than one or less than five genes is ordered, use the corresponding existing panel CPT code or CPT code 81479 if none exists.

Revised 2/5/2024
Posted 7/22/2021