Summary & Overview
CPT 81402: Advanced Molecular Pathology Procedure for Genetic Variant Analysis
CPT code 81402 is a Level 3 molecular pathology procedure used for advanced genetic testing, including the analysis of multiple genetic variants and rearrangements. This code is significant nationally as it enables laboratories to provide critical diagnostic information for conditions such as chromosomal abnormalities, metabolic disorders, and certain cancers, including follicular lymphoma. The procedure is typically performed in specialized laboratories outside of hospital settings, reflecting the growing role of molecular diagnostics in modern healthcare.
Major payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Readers will gain insights into payer coverage policies, clinical benchmarks, and recent policy updates relevant to molecular pathology services. The publication also provides context on how CPT 81402 fits within the broader landscape of genetic testing codes, highlighting its clinical applications and importance for laboratory medicine.
This summary offers a comprehensive overview of the code’s clinical relevance, payer landscape, and key considerations for laboratories and healthcare organizations navigating molecular pathology billing and coverage.
CPT Code Overview
CPT 81402 represents a Level 3 molecular pathology procedure. This code is used for advanced genetic testing, including analysis of more than 10 single nucleotide polymorphisms (SNPs), 2-10 methylated variants, or 2-10 somatic variants, typically using non-sequencing target variant analysis. It also covers immunoglobulin and T-cell receptor gene rearrangements, as well as duplication or deletion variants involving a single exon. A common clinical example is the analysis of the IGH@/BCL2 translocation, which is relevant in conditions such as follicular lymphoma, focusing on both major breakpoint region (MBR) and minor cluster region (mcr) breakpoints.
The service type for CPT 81402 is Molecular Pathology, and the typical site of service is a laboratory other than a hospital (POS 81). This code is integral for laboratories performing complex genetic analyses that inform diagnosis and treatment decisions in a variety of clinical scenarios.
Clinical & Coding Specifications
Clinical Context
A patient presents to their healthcare provider with clinical suspicion of a genetic or chromosomal abnormality, metabolic disorder, or abnormal laboratory findings such as unusual results in urine or liver function studies. The provider orders a molecular pathology procedure to analyze specific genetic variants, such as immunoglobulin and T-cell receptor gene rearrangements or translocation analysis (e.g., IGH@/BCL2 (t(14;18)) for follicular lymphoma). The specimen is sent to a laboratory (other than a hospital, Place of Service 81) specializing in molecular genetic pathology. The laboratory performs a Level 3 molecular pathology procedure, which may involve qualitative or quantitative analysis of major and minor breakpoint regions. Results are reported back to the provider for clinical interpretation and management.
Coding Specifications
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Modifier
26: Used to indicate the professional component of the molecular pathology procedure, typically when the physician interprets the results but does not perform the technical portion. -
Modifier
91: Used when the clinical diagnostic laboratory test is repeated on the same patient to obtain additional information.
| Modifier Code | Description |
|---|---|
26 |