Summary & Overview
CPT 81407: Advanced Molecular Pathology Genetic Analysis
CPT code 81407 represents a high-complexity molecular pathology procedure used for extensive genetic analysis, including DNA sequencing of multiple exons and genes. This code is critical in the landscape of genetic testing, enabling clinicians to identify mutations, duplications, or deletions across a broad range of genetic material. The procedure is typically performed in laboratory settings and is essential for diagnosing hereditary conditions, guiding treatment decisions, and informing genetic counseling.
Major national payers such as Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare provide coverage for services billed under CPT code 81407. The publication offers insights into payer coverage policies, clinical benchmarks, and recent policy updates relevant to molecular pathology and genetic testing. Readers will gain an understanding of the clinical context for this code, including its role in screening for genetic and chromosomal anomalies, and how it fits within broader trends in precision medicine.
Key topics include payer coverage details, clinical indications, and the importance of advanced genetic testing in modern healthcare. The summary also highlights related codes and modifiers commonly used in billing, providing a comprehensive overview for stakeholders interested in laboratory-based molecular diagnostics.
CPT Code Overview
CPT code 81407 is designated for advanced molecular pathology procedures, specifically Level 8 complexity. This code covers the analysis of 26‑50 exons by DNA sequence analysis, mutation scanning, or duplication/deletion variants of more than 50 exons, as well as sequence analysis of multiple genes on a single platform. The service type is molecular pathology and genetic testing, typically performed in a laboratory setting where the technical component is emphasized. This procedure is integral for comprehensive genetic screening and diagnosis, supporting clinical decision-making in a variety of specialties.
Clinical & Coding Specifications
Clinical Context
A patient is referred for advanced genetic testing due to a suspected hereditary disorder or chromosomal abnormality. The clinical workflow involves a physician (such as in Family Medicine, Internal Medicine, Obstetrics & Gynecology, or Pathology) ordering a molecular pathology procedure. The laboratory performs DNA sequence analysis covering 26-50 exons or mutation scanning/duplication/deletion analysis of more than 50 exons, potentially involving multiple genes on a single platform. The results are used to inform diagnosis, guide genetic counseling, or support screening for genetic and chromosomal anomalies.
Coding Specifications
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Modifiers:
26: Professional Component – Used when only the interpretation of the test is performed by the physician.TC: Technical Component – Used when only the laboratory performs the technical aspects of the test.91: Repeat Clinical Diagnostic Laboratory Test – Used when the same test is repeated on the same patient.
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Provider Taxonomies:
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