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The CPT® Code 81519 refers to a specialized laboratory test utilized in oncology, specifically for breast cancer. This test involves the analysis of messenger RNA (mRNA) gene expression profiling through real-time reverse transcriptase polymerase chain reaction (RT-PCR) of a total of 21 genes. The tissue sample used for this analysis is formalin-fixed paraffin-embedded tissue obtained from breast tumor(s). The primary aim of this test is to provide a recurrence score that assists healthcare providers in making informed decisions regarding chemotherapy treatment planning. The 21 genes analyzed include 16 cancer-related genes, such as Ki-67, STK 15, SURVIVIN, and HER2, among others, as well as 5 reference genes, including BETA-ACTIN and GAPDH. This comprehensive gene expression profiling is performed in conjunction with standardized tests for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status on the tumor tissue. The results of this test yield an algorithmically derived recurrence score, which is particularly relevant for patients with grade 1 or 2, unilateral, non-fixed tumors that are greater than 0.5 cm in size, ER positive or PR positive, HER2 negative, and without lymph node involvement. This score provides a quantitative analysis of the 10-year risk of distant disease recurrence, thereby aiding in the assessment of the potential benefits of adjuvant chemotherapy for the patient.
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The CPT® Code 81519 is indicated for use in patients with specific breast cancer characteristics. The following conditions must be met for the test to be performed:
The procedure for CPT® Code 81519 involves several key steps to ensure accurate gene expression profiling:
After the procedure associated with CPT® Code 81519, the patient may not require any specific post-procedure care related to the test itself, as it is a laboratory analysis rather than an invasive procedure. However, it is essential for the treating physician to discuss the results with the patient, including the implications of the recurrence score on treatment planning. The physician may recommend follow-up appointments to monitor the patient's condition and to discuss potential adjuvant chemotherapy options based on the test results. Additionally, the patient should be informed about any symptoms to watch for and the importance of adhering to follow-up care as part of their overall cancer management strategy.
| Short Descr | ONCOLOGY BREAST MRNA | Medium Descr | ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES | Long Descr | Oncology (breast), mRNA, gene expression profiling by real-time RT-PCR of 21 genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as recurrence score | 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 | 1 |
| 91 | Repeat clinical diagnostic laboratory test: in the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of modifier 91. note: this modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. this modifier may not be used when other code(s) describe a series of test results (eg, glucose tolerance tests, evocative/suppression testing). this modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit |
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| 2018-01-01 | Changed | Code description changed. |
| 2015-01-01 | Added | Added |
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