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

Genomic sequence analysis panels (CPT 81450/81451) for hematolymphoid neoplasms such as AML, MDS, and MPN are covered when the panel includes at least five genes that are molecular biomarkers meeting Medicare coverage criteria (e.g., NCCN Evidence Category I or 2A) and have demonstrated clinical utility. Billing must include a valid ICD-10-CM diagnosis and, when applicable, the referring/ordering physician's name and NPI; coding may be subject to NCCI or OPPS edits. Inclusion of genes not addressed by NCCN or other professional guidelines is not endorsed by this policy and may require institutional/regulatory oversight.

"Targeted genomic sequence analysis panels (CPT 81450 or 81451) for hematolymphoid neoplasms (including AML, MDS, MPN) are covered when the panel contains at least 5 genes that are molecular biomark..."

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