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The CPT® Code 81287 pertains to the analysis of the MGMT (O-6-methylguanine-DNA methyltransferase) gene promoter methylation, specifically in the context of glioblastoma multiforme, which is recognized as a prevalent and aggressive form of malignant brain tumor. This procedure involves the examination of paraffin-embedded biopsy tissue samples to determine the methylation status of the MGMT gene promoter. The significance of this analysis lies in its potential to influence treatment decisions, particularly regarding the use of alkylating chemotherapy agents such as Temodar (temozolomide). The MGMT enzyme plays a critical role in DNA repair by reversing the alkylation of guanine, a process that, when disrupted due to promoter methylation, can lead to an accumulation of alkylguanine DNA. This accumulation results in erroneous base pairings with thymine, ultimately causing DNA damage and triggering cell death. The assessment of MGMT gene promoter methylation can be performed using advanced techniques such as methylation-specific polymerase chain reaction (PCR) or pyrosequencing methylation assays, which provide precise insights into the methylation status and its implications for patient prognosis and treatment response.
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The MGMT promoter methylation analysis is indicated for patients diagnosed with glioblastoma multiforme, a highly aggressive malignant brain tumor. The presence of methylation in the MGMT gene promoter is associated with a more favorable response to alkylating chemotherapy agents, which are commonly used in the treatment of this condition.
The procedure for MGMT promoter methylation analysis involves several key steps to ensure accurate results. First, a biopsy of the tumor tissue is obtained and then processed to create paraffin-embedded samples. This preservation method allows for the long-term storage and analysis of the tissue. Once the samples are prepared, they undergo a series of laboratory techniques to assess the methylation status of the MGMT gene promoter. The most common methods employed include methylation-specific polymerase chain reaction (PCR) and pyrosequencing methylation assays. These techniques are designed to detect the presence or absence of methylation at specific sites within the promoter region of the MGMT gene. The results of this analysis provide critical information that can guide treatment decisions and prognostic evaluations for patients with glioblastoma multiforme.
After the MGMT promoter methylation analysis is completed, the results are interpreted by healthcare professionals to determine the methylation status of the MGMT gene. This information is crucial for making informed treatment decisions regarding the use of alkylating chemotherapy agents. Patients may be monitored for any side effects related to their treatment, and follow-up care will be tailored based on the results of the analysis and the overall treatment plan. It is important for healthcare providers to discuss the implications of the test results with patients, including how the methylation status may affect prognosis and treatment options.
| Short Descr | MGMT GENE PRMTR MTHYLTN ALYS | Medium Descr | MGMT GENE PROMOTER METHYLATION ANALYSIS | Long Descr | MGMT (O-6-methylguanine-DNA methyltransferase) (eg, glioblastoma multiforme) promoter methylation analysis | 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 |
| 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. | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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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| 2019-01-01 | Changed | Description Changed |
| 2014-01-01 | Added | Added |
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