Reimbursement
$0.00
Threshold
N/A
2026 Status
Active
What is CPT Code 81479?
CPT 81479 is defined as: A CPT code used for molecular pathology procedures that do not have a specific, dedicated CPT code. This includes novel genetic tests, proprietary molecular assays, or specialized DNA/RNA analyses that are not described by codes 81105-81471. Due to its unlisted nature, this code requires manual review by payers and detailed clinical justification.
This code is primarily used for Labs services. It falls under the category of Pathology and Laboratory / Molecular Pathology and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
0
Physician Effort
PE (Non-Fac)
0
Practice Expense
Malpractice
0
Risk Factor
Total RVU
0
Note: Contractor Priced. Payment determined by individual MACs or private payers based on methodology and utility.
2026 CMS Policy Intelligence
contractor pricing
In 2026, CMS continues to delegate pricing for 81479 to individual Medicare Administrative Contractors (MACs) under the Clinical Laboratory Fee Schedule (CLFS).
moldx scrutiny
Many jurisdictions follow the 'MolDX' program, which requires a formal Technical Assessment (TA) and a unique 'Z-Code' identifier for 81479 claims to be processed.
conversion factor
The $33.40 conversion factor is used as a reference; however, reimbursement is typically a flat fee per the CLFS.
Administrative Framework
Place of Service
NCCI Exclusions
Key Modifiers
Operational Requirements
manual review package
Claims for 81479 must be accompanied by a concise description of the test, including the methodology, the genes or markers analyzed, and the clinical purpose.
pricing reference
It is highly recommended to include a 'comparable' CPT code in the narrative field of the claim to suggest a pricing baseline to the payer.
clia certification
The laboratory must maintain the appropriate level of CLIA certification for high-complexity molecular testing.
box 19 narrative
Enter the name of the test and a brief description in Box 19 of the CMS-1500 form or the electronic equivalent.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
Manual review required. Z-code/unique identifier frequently mandated in MolDX jurisdictions.
Common Clinical Scenarios
No clinical examples provided.
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Frequently Asked Questions
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