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The CPT® Code 81210 pertains to the molecular genetic testing of the BRAF gene, specifically focusing on the V600 variant(s). This testing is crucial for identifying mutations in the BRAF (B-Raf proto-oncogene, serine/threonine kinase) gene, which are commonly associated with certain types of cancer, including colorectal cancer and melanoma. The BRAF gene encodes a protein that is part of the raf/mil family of serine/threonine protein kinases, which play a significant role in regulating the MAP kinase/ERK signaling pathways. These pathways are essential for various cellular processes, including cell division, differentiation, and secretion. When mutations occur in the BRAF gene, particularly the V600 variant, they can lead to the production of an altered B-Raf protein that is constitutively active. This means that the protein is continuously signaling the cell to grow and divide, which can result in uncontrolled cell proliferation and contribute to the development of cancer. The most prevalent mutation involves the substitution of the amino acid valine with glutamic acid at position 600 of the BRAF gene. Over 30 different mutations of the BRAF gene have been documented, and genetic testing for these mutations is performed to assist in the diagnosis and treatment planning for patients with cancer. Identifying the specific BRAF mutation can guide oncologists in selecting targeted therapies, such as the chemotherapeutic agents dabrafenib, trametinib, and vemurafenib, which are designed to inhibit the activity of the mutated B-Raf protein and improve treatment outcomes for patients.
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The BRAF gene analysis (CPT® Code 81210) is indicated for patients diagnosed with specific types of cancer, particularly:
The procedure for BRAF gene analysis involves several key steps to ensure accurate identification of the V600 variant(s). Each step is crucial for obtaining reliable results:
After the BRAF gene analysis is completed, the results are typically available within a specified timeframe, depending on the laboratory's processing capabilities. Healthcare providers will review the results with the patient, discussing the implications of the findings for treatment options. If a BRAF V600 mutation is identified, oncologists may consider targeted therapies that specifically address the mutation, potentially improving treatment efficacy. Additionally, follow-up care may include monitoring for treatment response and managing any side effects associated with the chosen therapeutic regimen.
| Short Descr | BRAF GENE | Medium Descr | BRAF GENE ANALYSIS V600 VARIANT(S) | Long Descr | BRAF (B-Raf proto-oncogene, serine/threonine kinase) (eg, colon cancer, melanoma), gene analysis, V600 variant(s) | 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. | GZ | Item or service expected to be denied as not reasonable and necessary | GW | Service not related to the hospice patient's terminal condition | 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. | GC | This service has been performed in part by a resident under the direction of a teaching physician | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 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. | 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. | GA | Waiver of liability statement issued as required by payer policy, individual case | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | 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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| 2016-01-01 | Changed | Description Changed |
| 2012-01-01 | Added | Added |
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