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Reimbursement Policy: Genetic and Molecular Testing – Molecular Pathology Procedures Update

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December 01, 2025
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Claims & Coding
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Claims & Coding
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Effective February 1, 2026, for molecular pathology procedures, if a panel code is not appropriate or is not specified in code ranges 81161 and 81200-81383, providers may be eligible for reimbursement by reporting one unit of the unlisted molecular pathology procedure code 81479.

Please see the related policy notification for more information.

This policy applies to Commercial, Inter-Plan Program (IPP) Host, and Federal Employee Program (FEP). This does not apply to Medicare Advantage or IPP Home.

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