Circulating Tumor DNA and Circulating Tumor Cells for Cancer Management (Liquid Biopsy)

Original Effective Date: February 27, 2021

CODING:

The following codes for treatment and procedures applicable to this policy are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement. Please refer to the member’s contract benefits in effect at the time of service to determine coverage or noncoverage of these services as it applies to an individual member.

CPT/HCPS:

• 81400 Molecular Pathology Procedure, Level 1 (Eg, Identification Of Single Germline Variant [Eg, Snp] By Techniques Such As Restriction Enzyme Digestion Or Melt Curve Analysis)
• 81401 Molecular Pathology Procedure, Level 2 (Eg, 2-10 Snps, 1 Methylated Variant, Or 1 Somatic Variant [Typically Using Nonsequencing Target Variant Analysis], Or Detection Of A Dynamic Mutation Disorder/Triplet Repeat
• 81402 Molecular Pathology Procedure, Level 3 (Eg, >10 Snps, 2-10 Methylated Variants, Or 2-10 Somatic Variants [Typically Using Non-Sequencing Target Variant Analysis], Immunoglobulin And T-Cell Receptor Gene Rearrangements, Duplication/Deletion Variants Of 1 Exon
• 81403 Molecular Pathology Procedure, Level 4 (Eg, Analysis Of Single Exon By Dna Sequence Analysis, Analysis Of >10 Amplicons Using Multiplex Pcr In 2 Or More Independent Reactions, Mutation Scanning Or Duplication/Deletion Variants Of 2-5 Exons)
• 81404 Molecular Pathology Procedure, Level 5 (Eg, Analysis Of 2-5 Exons By Dna Sequence Analysis, Mutation Scanning Or Duplication/Deletion Variants Of 6-10 Exons, Or Characterization Of A Dynamic Mutation Disorder/Triplet Repeat By Southern Blot Analysis)
• 81405 Molecular Pathology Procedure, Level 6 (Eg, Analysis Of 6-10 Exons By Dna Sequence Analysis, Mutation Scanning Or Duplication/Deletion Variants Of 11-25 Exons, Regionally Targeted Cytogenomic Array Analysis)
• 81406 Molecular Pathology Procedure, Level 7 (Eg, Analysis Of 11-25 Exons By Dna Sequence Analysis, Mutation Scanning Or Duplication/Deletion Variants Of 26-50 Exons)
• 81407 Molecular Pathology Procedure, Level 8 (Eg, Analysis Of 26-50 Exons By Dna Sequence Analysis, Mutation Scanning Or Duplication/Deletion Variants Of >50 Exons, Sequence Analysis Of Multiple Genes On One Platform)
• 81408 Molecular Pathology Procedure, Level 9 (Eg, Analysis Of >50 Exons In A Single Gene By Dna Sequence Analysis)
• 81479 Unlisted Molecular Pathology Procedure 86152 Cell Enumeration Using Immunologic Selection And Identification In Fluid Specimen (Eg, Circulating Tumor Cells In Blood); 86153 Cell Enumeration Using Immunologic Selection And Identification In Fluid Specimen (Eg, Circulating Tumor Cells In Blood); Physician Interpretation And Report, When Required
• 0091U Oncology (Colorectal) Screening, Cell Enumeration Of Circulating Tumor Cells, Utilizing Whole Blood, Algorithm, For The Presence Of Adenoma Or Cancer, Reported As A Positive Or Negative Result