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