Analysis provided by: Billie Mildenberger, Director of Audit Services, Lighthouse RCM Solutions
Starting Jan. 1, 2025, there are 9 revisions, 114 additions, and 14 deletions for Pathology and Lab CPT codes. Many of these changes are to PLA (Proprietary Laboratory Analysis) codes (101 additions, 4 revisions, & 8 deletions).
Many of the revisions to CPT codes just have description changes (ie, change from “sequencing of at least 10 genes” to deleting at least 10 genes or changing “targeted genomic sequence analysis panel” to “genomic sequence analysis panel”). Description changes for some NGS codes have been modified to remove the types of genes that could be tested (in red). Also, some cancers have been added to the descriptor (in green). An example is below:
81432-Hereditary breast cancer-related (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer, hereditary pancreatic cancer, hereditary prostate cancer), genomic sequence analysis panel, 5 or more genes, interrogations for sequence variants and copy number variants; genomic sequence analysis panel, must include sequencing of at least 10 genes, always including BRCA1, BRCAS2, CHD1, MH1, MSH2, MSH6, PALB2, PTEN, STK11 and TP53. (Do not report 81432 in conjunction with 81435, 81437.
See below for deleted CPT codes for 2025, these codes have been deleted due to low utilization:
81433-Hereditary breast cancer-related disorders (eg, hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer); duplication/deletion analysis panel, must include analyses for BRCA1, BRCA2, MLH1, MSH2, and STK11
81436-Hereditary colon cancer disorders (eg, Lynch syndrome, PTEN hamartoma syndrome, Cowden syndrome, familial adenomatosis polyposis); duplication/deletion analysis panel, must include analysis of at least 5 genes, including MLH1, MSH2, EPCAM, SMAD4, and STK11
81438-Hereditary neuroendocrine tumor disorders (eg, medullary thyroid carcinoma, parathyroid carcinoma, malignant pheochromocytoma or paraganglioma); duplication/deletion analysis panel, must include analyses for SDHB, SDHC, SDHD, and VHL
86327-Immunoelectrophoresis; crossed (2-dimensional assay)
86490– Skin test; coccidioidomycosis
88388-Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies (eg, nucleic acid-based molecular studies); in conjunction with a touch imprint, intraoperative consultation, or frozen section, each tissue preparation (eg, a single lymph node) (List separately in addition to code for primary procedure)
See below for new CPT codes for Molecular and Digital Pathology:
TIER 1 MOLECULAR PATHOLOGY PROCEDURES
- 81195 – Cytogenomic (genome-wide) analysis, hematologic malignancy, structural variants and copy number variants, optical genome mapping (OGM)
GENOMIC SEQUENCING PROCEDURES AND OTHER MOLECULAR MULTIANALYTE ASSAYS (MAAA)
- 81515 – Infectious disease, bacterial vaginosis and vaginitis, real-time PCR amplification of DNA markers for Atopobium vaginae, Atopobium species, Megasphaera type 1, and Bacterial Vaginosis Associated Bacteria-2 (BVAB-2), utilizing vaginal-fluid specimens, algorithm reported as positive or negative for high likelihood of bacterial vaginosis, includes separate detection of Trichomonas vaginalis and Candida species (C. albicans, C. tropicalis, C. parapsilosis, C. dubliniensis), Candida glabrata/Candida krusei, when reported. (This CPT is for manufacturer/laboratory Cepheid BV test, previously coded 0352U which is not deleted)
- 81558 – Transplantation medicine (allograft rejection, kidney), mRNA, gene expression profiling by quantitative polymerase chain reaction (qPCR) of 139 genes, utilizing whole blood, algorithm reported as a binary categorization as transplant excellence, which indicates immune quiescence, or not transplant excellence, indicating subclinical rejection. (This CPT is for manufacturer/laboratory TruGraf)
- 0020M – Oncology (central nervous system), analysis of 30000 DNA methylation loci by methylation array, utilizing DNA extracted from tumor tissue, diagnostic algorithm reported as probability of matching a reference tumor subclass (This CPT is for manufacturer/laboratory Epignostix CNS Tumor Methylation Classifier, Heidelberg Epignostix GmbH).
CHEMISTRY
- 82233 – Beta-amyloid; 1-40 (Abeta 40)
- 82434 – Beta-amyloid; 1-42 (Abeta 42)
- 83884 – Neurofilament light chain (NfL)
- 84393 – Tau, phosphorylated (eg, pTau 181, pTau 217), each
- 84394 – tau, total (tTau)
IMMUNOLOGY, MICROBIOLOGY & MOLECULAR MICROBIOLOGY
- 86581 – Streptococcus pneumoniae antibody (IgG), serotypes, multiplex immunoassay, quantitative
- 87594 – Pneumocystis jirovecii, amplified probe technique (BAL specimen sent for PCR testing)
- 87531 – Helicobacter pylori (H. pylori), clarithromycin resistance, amplified probe technique. (For H pylori, stool use 87338), (For H pylori, immunoassay use 87339), (For assays that detect clarithromycin resistance and identify H pylori using as single procedure, use 87513), (For H pylori, without clarithromycin resistance by amplified probe nucleic acid testing, use 87798)
- 87564 – Mycobacterium tuberculosis, rifampin resistance, amplified probe technique (For assays that detect rifampin resistance and identify Mycobacterium tuberculosis using a single procedure use 87564)
- 87626 – Human Papillomavirus (HPV), separately reported high-risk types (eg, 16,18, 31, 45, 51, 52) and high-risk pooled result(s). (Do not 87626 in conjunction with 87624, 87625 for the same procedure), (For singular pooled result of high-risk HPV types [eg, 16, 18, 31, 33, 39, 45, 51, 52, 58, 59, 68], use 87624), (For separately reported high-risk HPV types 16 and 18 only, including type 45, if performed, use 87625). 87626 used to be reported with Category III code 0500T, which has been deleted)
CELLULAR & GENE THERAPIES: CHIMERICA ANTIGEN RECEPTOR T-CELL (CAR-T) THERAPY SERVICES
- Cellular and Gene Therapies involve the collection, processing, and handling of cells or other tissues, genetic modification of those cells or tissues and administration of the genetically modified cells or tissues with the intent to treat, modify, reverse, or cure a serious or life-threatening disease or condition. All 4 new CPT codes were transferred from Category III codes
- 38225 – Chimeric antigen receptor T-cell (CAR-T) therapy; harvesting of blood-derived T lymphocytes for development of genetically modified autologous CAR-T cells, per day. This CPT used to be Category III code 0537T which has been deleted. This CPT is only reported once per day regardless of the number of collections or quantity of cells collected.
- 38226 – Chimeric antigen receptor T-cell (CAR-T) therapy; preparation of blood-derived T lymphocytes for transportation (eg, cryopreservation, storage). This CPT used to be Category III code 0538T which has been deleted.
- 38227 – Chimeric antigen receptor T-cell (CAR-T) therapy; receipt and preparation of CAR-T cells for administration. This CPT used to be 0539T, which has been deleted
- 38228 – Chimeric antigen receptor T-cell (CAR-T) therapy; CAR-T cell administration, autologous. This CPT used to be Category III 0540T which has been deleted. This CPT is only reported once per day regardless of the number of units administered.
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