CPT code 81479 can be used for an unlisted molecular pathology procedure not represented by any available standard and active CPT codes.
What Is CPT Code 81479?
CPT code 81479, “Unlisted molecular pathology procedure,” is a code used to bill for a molecular pathology procedure that is not represented by any of the available standard and active CPT codes.
Ensure to provide as much information as possible to the payer, such as the name of the test, the method used, and the reason for performing the test.
This will help the payer understand why you bill unlisted molecular pathology with CPT 81479 and accurately determine coverage and reimbursement.
CPT 81479 result in a lower reimbursement or denied claims as the payer may not recognize the procedure as medically necessary. Clear documentation and justification of the procedure can positively impact reimbursement.
The CPT book defines CPT code 81479 as: “Unlisted molecular pathology procedure.”
The laboratory analyst, skilled in molecular pathology, performs a procedure that falls outside the standard and active codes recognized by the Current Procedural Terminology (CPT) system.
While not listed in the standard CPT codes, an unlisted procedure can still be vital to the molecular pathology process and necessary for the accurate diagnosis and treatment of patients.
Despite not having a specific code to reference, the laboratory analyst can expertly perform this procedure and provide accurate information for healthcare providers.
How To Use CPT 81479
When reporting a molecular pathology procedure that does not have a corresponding standard or active CPT code, you may use CPT 81479 for an unlisted procedure.
However, if a more specific Category III code is available, it should be used instead of CPT code 81479.
Make sure to submit a cover letter explaining the reason for choosing the unlisted code 81479 and include one or more similar codes and other relevant documentation to justify the billed claim amount.
Payers will review claims with unlisted procedure codes on a case-by-case basis and make payment decisions based on the documentation provided.