Summary & Overview
CPT 81460: Genomic Sequencing Procedures for Genetic Testing
CPT code 81460 is a nationally recognized procedural code for genomic sequencing and molecular multianalyte assays, specifically used in genetic testing. This code is integral to the identification and analysis of genetic abnormalities, supporting clinical decision-making in areas such as chromosomal disorders, metabolic conditions, and congenital syndromes. The service is typically performed in laboratory settings, reflecting the technical complexity and specialized expertise required.
Major payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare provide coverage for services billed under CPT 81460, underscoring its widespread clinical and reimbursement relevance. Readers will gain insight into payer coverage policies, clinical indications, and the role of genetic testing in modern healthcare. The publication also addresses associated ICD-10 diagnoses, relevant modifiers, and related CPT codes, offering a comprehensive overview for stakeholders seeking to understand benchmarks, policy updates, and the evolving landscape of molecular diagnostics.
This summary provides a clear framework for understanding CPT 81460, its clinical applications, and its significance in the context of payer coverage and laboratory-based genetic testing.
CPT Code Overview
CPT 81460 is a procedural code maintained by the American Medical Association under the category of Genomic Sequencing Procedures and Other Molecular Multianalyte Assays. This code is used for genetic testing services, which involve comprehensive analysis of genetic material to identify mutations, chromosomal abnormalities, or other molecular markers relevant to patient care. The typical site of service for procedures billed under CPT 81460 is a laboratory setting, designated as Place of Service 81. Genetic testing plays a crucial role in diagnosing and managing a wide range of conditions, providing valuable information for clinicians and patients alike.
Clinical & Coding Specifications
Clinical Context
A patient presents with clinical features suggestive of a genetic disorder, such as unexplained developmental delay, congenital anomalies, or suspected chromosomal abnormalities. The ordering provider, typically a medical geneticist, requests comprehensive genomic sequencing to identify potential genetic causes. The procedure corresponding to CPT code 81460 is performed in a laboratory setting (Place of Service 81), where advanced molecular techniques are used to analyze multiple genes or regions of the genome. Results are interpreted by specialists in medical genetics and reported back to the provider for clinical management.
Coding Specifications
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Modifiers:
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26: Used when reporting only the professional component of the service, such as interpretation of the genetic test results by a qualified provider. - Modifier
TC: Used when reporting only the technical component, which includes the laboratory processing and analysis of the specimen.
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Associated Provider Taxonomies:
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