Billing and Coding: Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Diseases

Medicare allows targeted genomic sequence analysis panels for hematolymphoid neoplasms (AML, MDS, MPN) when panels include at least five gene tests for biomarkers that meet Medicare coverage criteria (for example NCCN Evidence Category I or 2A) and align with NCCN recommendations; panels are billed using CPT codes 81450/81451 (5–50 genes) or 81455/81456 (51+ genes). Claims must include a valid ICD-10-CM diagnosis and, when applicable, the ordering/referring physician's name and NPI; inclusion of genes not addressed by professional guidelines does not imply endorsement and coverage for MRD or single-gene testing in MDS is determined on a case-by-case basis based on medical necessity.

"Targeted genomic sequence analysis panels for hematolymphoid neoplasms (including acute myelogenous leukemia, myelodysplastic syndromes, and myeloproliferative neoplasms) are covered when the panel..."