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Apurva Posted Tue 18th of February, 2020 03:43:27 AM
Do we have a replacement CPT code for 81265 AND 81266
SuperCoder Answered Wed 19th of February, 2020 06:35:30 AM



There is no replacement code for CPT 81265 and 81266.

Generally, replacement codes are billed for deleted codes. The CPT codes 81265 and 81266 are active codes which are used to evaluate Short Tandem Repeat, or STR, markers to compare genetic similarity in the patient and a specimen from another person and cannot be replaced by other codes.

Note: As per the guidelines, you may separately report prep work that precedes cell lysis, when documented, such as tissue selection from archived specimens, which you can report with 88363; or microdissection, which you can report with 88380; or special macroscopic dissection, which you can report with 88387 or +88388.

If the ordering clinician separately requests physician interpretation of the 81265 test and the pathologist renders an interpretation and writes a report, you can additionally report G0452 with modifier 26 to Medicare and perhaps other payers. An MD or DO physician must perform the interpretation, not a PhD laboratory scientist, according to CMS.


Hope this helps!



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