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The CPT® Code 81433 pertains to molecular genetic testing specifically designed to identify hereditary breast cancer-related disorders. These disorders include hereditary breast cancer, hereditary ovarian cancer, and hereditary endometrial cancer. The procedure involves a duplication/deletion analysis panel that must include analyses for specific genes: BRCA1, BRCA2, MLH1, MSH2, and STK11. This testing is crucial for individuals with a family history of these cancers, as it helps in determining the presence of genetic mutations that may increase the risk of developing these types of cancer. The analysis is performed on genetic material, typically extracted from a specimen of whole blood, and aims to detect variations in the genes that are associated with hereditary cancer syndromes. By identifying these genetic markers, healthcare providers can confirm diagnoses, guide treatment decisions, and assess the risk for family members who may also carry these inherited mutations.
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The procedure associated with CPT® Code 81433 is indicated for the following hereditary breast cancer-related disorders:
The procedure for CPT® Code 81433 involves several detailed steps to perform the duplication/deletion analysis:
After the completion of the genetic testing procedure, the results are analyzed and interpreted by qualified healthcare professionals. The findings can confirm a diagnosis of hereditary cancer and provide critical information for guiding treatment decisions. Additionally, the results may be used to identify family members who may be at increased risk for developing cancer due to inherited germ line mutations. It is essential for patients to receive genetic counseling to understand the implications of the test results and to discuss potential preventive measures or surveillance strategies for themselves and their relatives.
| Short Descr | HRDTRY BRST CA-RLATD DSORDRS | Medium Descr | HEREDITARY BRST CA-RELATED DUP/DEL ANALYSIS | Long Descr | 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 | Status Code | Statutory Exclusion (from MPFS, may be paid under other methodologies) | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | CLIA Waived (QW) | No | APC Status Indicator | Service Paid under Fee Schedule or Payment System other than OPPS | Type of Service (TOS) | 5 - Diagnostic Laboratory | Berenson-Eggers TOS (BETOS) | T1H - Lab tests - other (non-Medicare fee schedule) | MUE | Not applicable/unspecified. |
| GZ | Item or service expected to be denied as not reasonable and necessary | 90 | Reference (outside) laboratory: when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GA | Waiver of liability statement issued as required by payer policy, individual case |
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| 2024-12-31 | Deleted | Code Deleted. See 81479 |
| 2016-01-01 | Added | Added |
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