How To Use CPT Code 81455

CPT 81455 is a code for targeted genomic sequence analysis panel for solid organ or hematolymphoid neoplasm or disorder, involving 51 or greater genes. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 81455.

1. What is CPT 81455?

CPT 81455 is a code used to describe a targeted genomic sequence analysis panel for solid organ or hematolymphoid neoplasm or disorder, involving 51 or greater genes. This test is performed to evaluate the patient specimen for DNA and possibly RNA alterations in 51 or more genes known to relate to solid organ cancers or to blood or lymph (hematolymphoid) disorders or cancers.

2. 81455 CPT code description

The official description of CPT code 81455 is: “Targeted genomic sequence analysis panel, solid organ or hematolymphoid neoplasm or disorder, 51 or greater genes (eg, ALK, BRAF, CDKN2A, CEBPA, DNMT3A, EGFR, ERBB2, EZH2, FLT3, IDH1, IDH2, JAK2, KIT, KRAS, MET, MLL, NOTCH1, NPM1, NRAS, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed; DNA analysis or combined DNA and RNA analysis.”

3. Procedure

1. The lab analyst processes the patient specimen, such as tumor tissue or bone marrow, to extract nucleic acids.
2. The target DNA and possibly RNA are amplified using a procedure such as polymerase chain reaction (PCR) or reverse transcription PCR (RT–PCR).
3. The lab analyst evaluates the nucleic acids with next-generation sequencing (NGS), an automated instrument that can simultaneously determine the order of DNA or RNA nucleotides in many genes from the patient specimen and use bioinformatics to interpret the results relative to genetic changes associated with certain conditions.
4. This test evaluates for sequence variants, copy number variants, and possibly rearrangements.
5. The analysis may specifically interrogate RNA to evaluate the impact on disease development and progression of gene expression and isoform expression, which is variation in RNA transcription from DNA that produces functionally different forms of the protein.

4. Qualifying circumstances

Patients eligible to receive CPT code 81455 services are those with solid tissue tumors or hematolymphoid cancers or disorders. The test helps to characterize the genetic mutation and expression involved in the disease process and helps the clinician determine appropriate treatment.

5. When to use CPT code 81455

It is appropriate to bill the 81455 CPT code when a targeted genomic sequence analysis panel for solid organ or hematolymphoid neoplasm or disorder, involving 51 or greater genes, is performed to evaluate the patient specimen for DNA and possibly RNA alterations related to solid organ cancers or hematolymphoid disorders or cancers.

6. Documentation requirements

To support a claim for CPT 81455, the following information needs to be documented:

• Patient’s medical history and diagnosis
• Reason for performing the targeted genomic sequence analysis panel
• Details of the specimen collection and processing
• Results of the genomic sequence analysis, including any identified sequence variants, copy number variants, or rearrangements
• Interpretation of the results and their clinical significance
• Recommendations for treatment or further testing based on the results

7. Billing guidelines

When billing for CPT code 81455, keep in mind the following guidelines and rules:

• Do not additionally report a code for a test that evaluates a single gene if the 81455 panel test includes that gene.
• Use different codes for panels involving fewer genes, such as 81450 or 81451 for hematolymphoid cancer and 81445 or 81449 for solid tissue tumors.
• Some payers may pay separately for specimen preparation steps before the molecular analysis, such as microdissection, macroscopic preparation, or tissue selection from archived specimen.
• Some payers may pay separately for specimen collection.

8. Historical information

CPT 81455 was added to the Current Procedural Terminology system on January 1, 2015. There have been two updates since its addition:

• Code Changed on 01-01-2016
• Code Changed on 01-01-2023

9. Similar codes to CPT 81455

Five similar codes to CPT 81455 differentiate as follows:

• CPT 81450: A genomic sequence panel for hematolymphoid cancer involving five to 50 genes, evaluating DNA and possibly RNA.
• CPT 81451: A genomic sequence panel for hematolymphoid cancer involving five to 50 genes, evaluating only RNA.
• CPT 81445: A genomic sequence panel for solid tissue tumors involving five to 50 genes, evaluating DNA and possibly RNA.
• CPT 81449: A genomic sequence panel for solid tissue tumors involving five to 50 genes, evaluating only RNA.
• CPT 81210, 81235, 81270, 81275, 81245: Codes for tests evaluating single genes, such as BRAF, EGFR, JAK2, KRAS, or FLT3, which should not be reported additionally if the 81455 panel test includes that gene.

10. Examples

Here are 10 detailed examples of CPT code 81455 procedures:

1. A patient with non-small cell lung cancer undergoes CPT 81455 to identify potential targeted therapies based on the genomic profile of their tumor.
2. A patient with acute myeloid leukemia has CPT 81455 performed to evaluate the presence of specific gene mutations that may impact prognosis and treatment options.
3. A patient with metastatic colorectal cancer undergoes CPT 81455 to identify potential resistance mechanisms to targeted therapies and guide treatment decisions.
4. A patient with multiple myeloma has CPT 81455 performed to assess the genomic landscape of their disease and identify potential therapeutic targets.
5. A patient with breast cancer undergoes CPT 81455 to evaluate the presence of specific gene alterations that may impact treatment decisions and prognosis.
6. A patient with a rare sarcoma has CPT 81455 performed to identify potential actionable genomic alterations that may guide treatment decisions.
7. A patient with a high-grade glioma undergoes CPT 81455 to assess the genomic profile of their tumor and identify potential targeted therapies.
8. A patient with a hematolymphoid disorder, such as myelodysplastic syndrome, has CPT 81455 performed to evaluate the presence of specific gene mutations that may impact prognosis and treatment options.
9. A patient with ovarian cancer undergoes CPT 81455 to identify potential therapeutic targets based on the genomic profile of their tumor.
10. A patient with a rare solid tumor has CPT 81455 performed to assess the genomic landscape of their disease and identify potential actionable genomic alterations that may guide treatment decisions.