Summary & Overview
CPT 81461: CYP2C19 Genetic Testing for Drug Metabolism
CPT code 81461 represents genetic analysis of the CYP2C19 gene, a key component in drug metabolism assessment. This test identifies common variants that can influence how patients process medications, supporting personalized medicine and safer prescribing practices. The code is widely recognized in clinical laboratories and is essential for guiding therapeutic decisions, especially for drugs metabolized by CYP2C19.
Blue Cross Blue Shield is a primary payer covered in this analysis. Readers will gain insights into national benchmarks for utilization, policy updates affecting coverage, and the clinical context for ordering CYP2C19 genetic testing. The publication also reviews associated taxonomies, relevant ICD-10 diagnoses, and related CPT codes, providing a comprehensive overview for stakeholders in medical genetics, pathology, and primary care.
Key topics include the importance of pharmacogenetic testing, payer coverage trends, and the role of laboratory services in supporting precision medicine. This summary equips healthcare professionals, administrators, and policy analysts with the latest information on CPT code 81461 and its impact on clinical practice and reimbursement.
CPT Code Overview
CPT code 81461 is used to report genetic testing for the CYP2C19 gene, which is part of the cytochrome P450 family. This test analyzes common variants such as *2, *3, *4, *5, *6, *7, *8, and *17 to assess drug metabolism. The service type is genetic testing, typically performed in a laboratory setting (Place of Service 81). This testing provides valuable information for understanding individual responses to medications and optimizing therapeutic strategies.
Clinical & Coding Specifications
Clinical Context
A patient is referred for genetic testing to evaluate their CYP2C19 gene variants, which influence drug metabolism. This testing is typically ordered when a patient is being considered for medications metabolized by CYP2C19, such as certain antiplatelet agents or antidepressants, to guide therapy and reduce adverse drug reactions. The workflow involves a physician (e.g., internal medicine, family medicine, or genetics specialist) ordering the test, sample collection (usually blood), and laboratory analysis in a facility designated as Place of Service 81 (Laboratory). Results are interpreted by a qualified provider, and findings may inform medication selection or dosing.
Coding Specifications
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Modifiers:
26: Professional Component – Used when only the interpretation of the test is performed by the provider, not the laboratory analysis.TC: Technical Component – Used when only the laboratory performs the technical aspects of the test, not the interpretation.
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Provider Taxonomies:
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