Billing and Coding: Molecular Pathology Procedures

This policy provides billing and coding rules for molecular pathology procedures, specifying required panel CPT codes for ordered gene panel sizes (5–50 genes: CPT 81445/81449/81450/81451; ≥51 genes: CPT 81455/81456) and use of CPT 81479 when no specific panel code exists. Coverage requires documentation that testing will influence treatment, valid ICD-10-CM diagnosis coding, and adherence to limits (e.g., one lifetime test for inherited conditions unless medically justified); screening and risk-only assessments are not covered.

"When a molecular panel of 5–50 genes is ordered, bill the appropriate panel CPT code (81445, 81449, 81450, or 81451) instead of submitting individual single-gene CPT codes."

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