Summary & Overview
CPT 81420: Fetal Chromosomal Aneuploidy Genomic Sequence Analysis Panel
CPT code 81420 represents a genomic sequence analysis panel for detecting fetal chromosomal aneuploidy, including conditions such as trisomy 21 (Down syndrome) and monosomy X, through the analysis of circulating cell-free fetal DNA in maternal blood. This test is a cornerstone of modern prenatal screening, offering non-invasive, highly accurate detection of chromosomal abnormalities by targeting chromosomes 13, 18, and 21. The service is typically performed in a laboratory setting and is classified under Genomic Sequencing / Molecular Pathology.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, provide coverage for this procedure, reflecting its widespread clinical adoption and importance in prenatal care. Readers will gain insights into payer coverage policies, clinical benchmarks, and recent policy updates relevant to CPT code 81420. The publication also explores the clinical context of the code, its role in prenatal screening, and its relationship to other molecular pathology procedures. This summary provides a comprehensive overview for healthcare professionals, laboratory administrators, and policy analysts seeking to understand the national landscape for fetal chromosomal aneuploidy testing.
CPT Code Overview
CPT code 81420 is used for genomic sequence analysis panels that detect fetal chromosomal aneuploidy, such as trisomy 21 and monosomy X, by analyzing circulating cell-free fetal DNA in maternal blood. This test must include analysis of chromosomes 13, 18, and 21. The service is classified under Genomic Sequencing / Molecular Pathology and is typically performed in a laboratory setting (Place of Service 81). This code is central to prenatal screening for chromosomal abnormalities, providing critical information for maternal and fetal health management.
Clinical & Coding Specifications
Clinical Context
A pregnant woman presents for routine prenatal care. Her obstetrician recommends non-invasive prenatal testing (NIPT) to screen for common fetal chromosomal aneuploidies, such as trisomy 21 (Down syndrome), trisomy 18, and trisomy 13. The test involves collecting a blood sample from the mother, which is sent to a laboratory (Place of Service 81) for genomic sequence analysis of circulating cell-free fetal DNA. The laboratory analyzes chromosomes 13, 18, and 21 to detect potential chromosomal abnormalities. Results are interpreted by a qualified provider, such as a genetic counselor or medical geneticist, and discussed with the patient as part of her prenatal care workflow.
Coding Specifications
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Modifiers:
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26: Used to indicate the professional component of the service, such as interpretation and reporting by a physician or qualified healthcare professional. - Modifier
TC: Used to indicate the technical component, which covers the laboratory processing and analysis of the specimen.
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