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The CPT® Code 81207 pertains to the molecular genetic testing aimed at identifying a specific mutation of the BCR/ABL1 gene, which is frequently associated with chronic myelogenous leukemia (CML). This mutation is characterized by a reciprocal translocation, denoted as t(9;22), which involves the BCR gene located on chromosome 22, commonly referred to as the Philadelphia chromosome, and the ABL1 gene situated on chromosome 9. The resultant fusion gene from this translocation encodes a tyrosine kinase that is unregulated and targets the cytoplasm, facilitating cell proliferation without the normal regulatory influence of cytokines. This unregulated growth predisposes individuals to certain types of cancers, particularly CML. Molecular testing, including techniques such as reverse transcription polymerase chain reaction (rtPCR) or fluorescence in situ hybridization (FISH), is essential at the initial diagnosis of CML. These tests help define tumor markers that are crucial for measuring residual disease during and after treatment. The BCR gene is known to have three distinct breakpoint cluster regions, which are critical for accurate diagnosis and treatment monitoring. For instance, CPT® Code 81206 is used for identifying the major breakpoint at p210, which occurs in the major breakpoint cluster region (M-bcr) around exon b3, leading to the formation of the BCR-ABL1 p210 chimeric transcript. In contrast, CPT® Code 81207 is specifically designated for the identification of the minor breakpoint at p190, which occurs in the minor breakpoint cluster region (m-bcr) on intron 1, resulting in the fusion of BCR exon 1 with the same ABL1 exons. Additionally, CPT® Code 81208 is available for identifying other breakpoint cluster regions that are not classified as major or minor. This structured approach to genetic testing is vital for the effective management and treatment of patients diagnosed with CML.
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The BCR/ABL1 translocation analysis using CPT® Code 81207 is indicated for the following conditions:
The procedure for conducting the BCR/ABL1 translocation analysis involves several key steps:
After the BCR/ABL1 translocation analysis is completed, the patient may not require any specific post-procedure care related to the test itself. However, it is essential for healthcare providers to review the results in conjunction with the patient's clinical status. The findings from the test will guide further treatment decisions and monitoring strategies for the patient diagnosed with CML. Regular follow-up and additional testing may be necessary to assess treatment efficacy and disease progression.
| Short Descr | BCR/ABL1 GENE MINOR BP | Medium Descr | BCR/ABL1 MINOR BREAKPNT QUALITATIVE/QUANTITATIVE | Long Descr | BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis; minor breakpoint, qualitative or quantitative | 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 | CCS Clinical Classification | 234 - Pathology |
| 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. | GZ | Item or service expected to be denied as not reasonable and necessary | 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 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. | GA | Waiver of liability statement issued as required by payer policy, individual case | GW | Service not related to the hospice patient's terminal condition | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2023-01-01 | Changed | Code description changed. |
| 2012-01-01 | Added | Added |
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