2024 Pathology Lab Guide: Navigating the Latest CPT Code Updates for Enhanced Laboratory Operations
Introduction
The field of pathology is continuously evolving, and keeping abreast of the latest CPT code updates is crucial for efficient laboratory operations and billing accuracy. The 2024 updates present significant changes, particularly in genomic sequencing, chemistry, immunology, and PLA codes. This guide is designed to help US pathology labs smoothly transition to these updates, ensuring compliance and operational efficiency.
Key CPT Code Additions for 2024
Genomic Sequencing Procedures and Multianalyte Assays:
CPT | CODE DESCRIPTION | PROCEDURE |
81457 | Solid organ neoplasm, genomic sequence analysis panel, interrogation for sequence variants; DNA analysis, microsatellite instability | DNA analysis, ‣microsatellite instability |
81458 | Solid organ neoplasm, genomic sequence analysis panel, interrogation for sequence variants; DNA analysis, copy number variants and microsatellite instability | DNA analysis, ‣copy number variants + ‣microsatellite instability |
81459 | Solid organ neoplasm, genomic sequence analysis panel, interrogation for sequence variants; DNA analysis or combined DNA and RNA analysis, copy number variants, microsatellite instability, tumor mutation burden, and rearrangements | DNA analysis or combined DNA & RNA analysis, ‣copy number variants, ‣microsatellite instability, ‣tumor mutation burden, & rearrangements |
81462 | Solid organ neoplasm, genomic sequence analysis panel, cell-free nucleic acid (eg, plasma), interrogation for sequence variants; DNA analysis or combined DNA and RNA analysis, copy number variants and rearrangements | cell-free nucleic acid (eg, plasma) DNA analysis or combined DNA & RNA analysis, ‣copy number variants, & rearrangements |
81463 | Solid organ neoplasm, genomic sequence analysis panel, cell-free nucleic acid (eg, plasma), interrogation for sequence variants; DNA analysis, copy number variants, and microsatellite instability | cell-free nucleic acid (eg, plasma) DNA analysis or combined DNA & RNA analysis, ‣copy number variants ‣microsatellite instability |
81464 | Solid organ neoplasm, genomic sequence analysis panel, cell-free nucleic acid (eg, plasma), interrogation for sequence variants; DNA analysis or combined DNA and RNA analysis, copy number variants, microsatellite instability, tumor mutation burden, and rearrangements |
Multianalyte Assays with Algorithmic Analyses (MAAA):
|
CPT |
CODE DESCRIPTION |
|
81517 |
Liver disease, analysis of 3 biomarkers (hyaluronic acid [HA], procollagen III amino terminal peptide [PIIINP], tissue inhibitor of metalloproteinase 1 [TIMP-1]), using immunoassays, utilizing serum, prognostic algorithm reported as a risk score and risk of liver fibrosis and liver-related clinical events within 5 years |
Chemistry:
|
CPT |
CODE DESCRIPTION |
|
82166 |
Anti-mullerian hormone (AMH) |
Immunology:
|
CPT |
CODE DESCRIPTION |
|
86041 |
Acetylcholine receptor (AChR); binding antibody |
|
86042 |
Acetylcholine receptor (AChR); blocking antibody |
|
86043 |
Acetylcholine receptor (AChR); modulating antibody |
|
86366 |
Muscle-specific kinase (MuSK) antibody |
|
87523 |
Infectious agent detection by nucleic acid (DNA or RNA); hepatitis D (delta), quantification, including reverse transcription, when performed |
|
87593 |
Infectious agent detection by nucleic acid (DNA or RNA); orthopoxvirus (eg, monkeypox virus, cowpox virus, vaccinia virus), amplified probe technique, each |
Proprietary Laboratory Analyses (PLA) Codes:
|
CPT |
CODE DESCRIPTION |
|
0420U |
Oncology (urothelial), mRNA expression profiling by real-time quantitative PCR of MDK, HOXA13, CDC2, IGFBP5, and CXCR2 in combination with droplet digital PCR (ddPCR) analysis of 6 single-nucleotide polymorphisms (SNPs) genes TERT and FGFR3, urine, algorithm reported as a risk score for urothelial carcinoma |
|
0421U |
Oncology (colorectal) screening, quantitative real-time target and signal amplification of 8 RNA markers (GAPDH, SMAD4, ACY1, AREG, CDH1, KRAS, TNFRSF10B, EGLN2) and fecal hemoglobin, algorithm reported as a positive or negative for colorectal cancer risk |
|
0422U |
Oncology (pan-solid tumor), analysis of DNA biomarker response to anti-cancer therapy using cell-free circulating DNA, biomarker comparison to a previous baseline pre-treatment cell-free circulating DNA analysis using next-generation sequencing, algorithm reported as a quantitative change from baseline, including specific alterations, if appropriate |
|
0423U |
Psychiatry (eg, depression, anxiety), genomic analysis panel, including variant analysis of 26 genes, buccal swab, report including metabolizer status and risk of drug toxicity by condition |
|
0424U |
Oncology (prostate), exosome based analysis of 53 small noncoding RNAs (sncRNAs) by quantitative reverse transcription polymerase chain reaction (RTqPCR), urine, reported as no molecular evidence, low-, moderate- or elevated-risk of prostate cancer |
|
0425U |
Genome (eg, unexplained constitutional or heritable disorder or syndrome), rapid sequence analysis, each comparator genome (eg, parents, siblings |
|
0426U |
Genome (eg, unexplained constitutional or heritable disorder or syndrome), ultra-rapid sequence analysis |
|
0427U |
Monocyte distribution width, whole blood (List separately in addition to code for primary procedure) |
|
0428U |
Oncology (breast), targeted hybrid-capture genomic sequence analysis panel, circulating tumor DNA (ctDNA) analysis of 56 or more genes, interrogation for sequence variants, gene copy number amplifications, gene rearrangements, microsatellite instability, and tumor mutation burden |
|
0429U |
Human papillomavirus (HPV), oropharyngeal swab, 14 high-risk types (ie, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68) |
|
0430U |
Gastroenterology, malabsorption evaluation of alpha-1-antitrypsin, calprotectin, pancreatic elastase and reducing substances, feces, quantitative |
|
0431U |
Glycine receptor alpha1 IgG, serum or cerebrospinal fluid (CSF), live cell-binding assay (LCBA), qualitative |
|
0432U |
Kelch-like protein 11 (KLHL11) antibody, serum or cerebrospinal fluid (CSF), cell-binding assay, qualitative |
|
0433U |
Oncology (prostate), 5 DNA regulatory markers by quantitative PCR, whole blood, algorithm, including prostate-specific antigen, reported as likelihood of cancer |
|
0434U |
Drug metabolism (adverse drug reactions and drug response), genomic analysis panel, variant analysis of 25 genes with reported phenotypes |
|
0435U |
Oncology, chemotherapeutic drug cytotoxicity assay of cancer stem cells (CSCs), from cultured CSCs and primary tumour cells, categorical drug response reported based on cytotoxicity percentage observed, minimum of 14 drugs or drug combinations |
|
0436U |
Oncology (lung), plasma analysis of 388 proteins, using aptamerbased proteomics technology, predictive algorithm reported as clinical benefit from immune checkpoint inhibitor therapy |
|
0437U |
Psychiatry (anxiety disorders), mRNA, gene expression profiling by RNA sequencing of 15 biomarkers, whole blood, algorithm reported as predictive risk score |
|
0438U |
Drug metabolism (adverse drug reactions and drug response), buccal specimen, gene-drug interactions, variant analysis of 33 genes, including deletion/duplication analysis of CYP2D6, including reported phenotypes and impacted gene drug interactions |
CPT Code Revisions for Enhanced Accuracy:
The document lists revisions in the CPT codes that reflect changes in terminology and procedures to enhance diagnostic precision and billing accuracy.
|
CPT |
2024 DESCRIPTION |
2023 DESCRIPTION |
|
81171 |
AFF2 (ALF transcription elongation factor 2 [FMR2]) (eg, fragile X intellectual disability 2 [FRAXE]) gene analysis; evaluation to detect abnormal (eg, expanded) alleles |
FF2 (AF4/FMR2 family, member [FMR2]) (eg, fragile X mental retardation 2 [FRAXE]) gene analysis; evaluation to detect abnormal (eg, expanded) alleles |
|
81172 |
AFF2 (ALF transcription elongation factor 2 [FMR2]) (eg, fragile X intellectual disability 2 [FRAXE]) gene analysis; characterization of alleles (eg, expanded size and methylation status) |
AFF2 (AF4/FMR2 family, member 2 [FMR2]) (eg, fragile X mental retardation 2 [FRAXE]) gene analysis; characterization of alleles (eg, expanded size and methylation status) |
|
81243 |
FMR1 (fragile X messenger ribonucleoprotein 1) (eg, fragile X syndrome, X-linked intellectual disability [XLID]) gene analysis; evaluation to detect abnormal (eg, expanded) alleles |
FMR1 (fragile X mental retardation 1) (eg, fragile X mental retardation) gene analysis; evaluation to detect abnormal (eg, expanded) alleles |
|
81244 |
FMR1 (fragile X messenger ribonucleoprotein 1) (eg, fragile X syndrome, X-linked intellectual disability [XLID]) gene analysis; characterization of alleles (eg, expanded size and promoter methylation status) |
FMR1 (fragile X mental retardation 1) (eg, fragile X mental retardation) gene analysis; characterization of alleles (eg, expanded size and promoter methylation status) |
|
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) ARX (aristaless related homeobox) (eg, X-linked lissencephaly with ambiguous genitalia, X-linked intellectual disability), duplication/deletion analysis |
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) ARX (aristaless-related homeobox) (eg, X-linked lissencephaly with ambiguous genitalia, X-linked mental retardation), duplication/deletion analysis |
|
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) ARX (aristaless related homeobox) (eg, X-linked lissencephaly with ambiguous genitalia, X-linked intellectual disability), full gene sequence |
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) ARX (aristaless related homeobox) (eg, X-linked lissencephaly with ambiguous genitalia, X-linked mental retardation), full gene sequence |
|
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) FTSJ1 (FtsJ RNA 2′-O-methyltransferase 1) (eg, X-linked intellectual disability 9), duplication/deletion analysi |
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) FTSJ1 (FtsJ RNA methyltransferase homolog 1 [E. coli]) (eg, X-linked mental retardation 9), duplication/deletion 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) FTSJ1 (FtsJ RNA 2′-O-methyltransferase 1) (eg, X-linked intellectual disability 9), full gene sequence |
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) FTSJ1 (FtsJ RNA methyltransferase homolog 1 [E. coli]) (eg, X-linked mental retardation 9), full gene sequence |
|
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) KDM5C (lysine demethylase 5C) (eg, X-linked intellectual disability), full gene sequence |
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) KDM5C (lysine [K]-specific demethylase 5C) (eg, X-linked mental retardation), full gene sequence |
|
81445 |
Solid organ neoplasm, genomic sequence analysis panel, 5-50 genes, interrogation for sequence variants and copy number variants or rearrangements, if performed: DNA analysis or combined DNA and RNA analysis |
Targeted genomic sequence analysis panel, solid organ neoplasm, 5-50 genes (eg, ALK, BRAF, CDKN2A, EGFR, ERBB2, KIT, KRAS, MET, NRAS, PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET), interrogation for sequence variants and copy number variants or rearrangements, if performed; DNA analysis or combined DNA and RNA analysi |
|
87467 |
Infectious agent antigen detection by immunoassay technique (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; hepatitis B surface antigen (HBsAg), quantitative |
Hepatitis B surface antigen (HBsAg), quantitative |
|
0351U |
Infectious disease (bacterial or viral), biochemical assays, tumor necrosis factorrelated apoptosis inducing ligand (TRAIL), interferon gamma-induced protein-10 (IP-10), and C-reactive protein, serum, or venous whole blood, algorithm reported as likelihood of bacterial infection |
Infectious disease (bacterial or viral), biochemical assays, tumor necrosis factor-related apoptosisinducing ligand (TRAIL), interferon gammainduced protein-10 (IP-10), and C-reactive protein, serum, algorithm reported as likelihood of bacterial infection |
|
0356U |
Oncology (oropharyngeal or anal), evaluation of 17 DNA biomarkers using droplet digital PCR (ddPCR), cell-free DNA, algorithm reported as a prognostic risk score for cancer recurrence |
Oncology (oropharyngeal), evaluation of 17 DNA biomarkers using droplet digital PCR (ddPCR), cell-free DNA, algorithm reported as a prognostic risk score for cancer recurrence |
The 2024 updates to pathology and laboratory CPT codes are designed to reflect the advancements in medical technology and practice. Pathology labs must adapt to these changes to maintain compliance, ensure accurate billing, and offer cutting-edge diagnostic services.
References:
AAPC: www.AAPC.com
AMA: https://www.ama-assn.org/press-center/press-releases/ama-releases-cpt-2024-code-set/
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