Summary & Overview
CPT 81470: Genomic Sequencing for Intellectual Disability Detection
CPT code 81470 represents a genomic sequencing procedure aimed at detecting genes associated with intellectual disability. This code is significant in the national landscape as it supports the identification of genetic causes for intellectual disability, which can inform clinical care and patient management. The procedure is typically performed in CLIA-certified laboratories and is recognized by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.
Readers will gain insight into payer coverage policies, relevant clinical contexts, and associated billing practices for this code. The publication covers benchmarks, policy updates, and the clinical importance of genomic sequencing in intellectual disability. It also highlights common modifiers used in billing, associated taxonomies for provider types, and relevant ICD-10 diagnoses. Additionally, related CPT codes are discussed to provide a comprehensive view of the coding landscape for intellectual disability genetic testing. This summary equips stakeholders with the information needed to understand the role and reimbursement environment for CPT code 81470 across the United States.
CPT Code Overview
CPT code 81470 is used for genomic sequencing procedures that detect genes associated with intellectual disability. This test falls under the Pathology and Laboratory – Genomic Sequencing Procedures service type and is typically performed in a laboratory setting, most often in a CLIA-certified lab designated as Place of Service 81. The procedure is designed to identify genetic factors contributing to intellectual disability, supporting clinical decision-making and patient management.
Clinical & Coding Specifications
Clinical Context
A child presents to a family medicine physician with developmental delays and learning difficulties. After initial evaluation and history, the physician refers the patient for genetic testing to investigate potential underlying causes of intellectual disability. The test is performed in a CLIA-certified laboratory (Place of Service 81) by a clinical pathology specialist. The workflow involves sample collection, genomic sequencing, and interpretation of results to identify genes associated with intellectual disability. The results may inform further management and counseling for the patient and family.
Coding Specifications
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Modifiers:
GX: Used when a notice of liability is issued voluntarily under payer policy, such as when Blue Cross Blue Shield, Cigna Health, or UnitedHealthcare require notification for non-covered services.GY: Applied when the item or service is statutorily excluded and does not meet the definition of any Medicare benefit, or for non-Medicare insurers (Aetna, BCBS, Cigna Health, UHC, BUCA), is not a contract benefit.
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Provider Taxonomies:
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