Summary & Overview
CPT 81474: CYP2C19 Gene Analysis for Drug Metabolism
CPT code 81474 represents genetic analysis of the CYP2C19 gene, a key enzyme involved in drug metabolism. This test identifies common genetic variants that can influence how patients respond to medications, supporting personalized treatment strategies and improving clinical outcomes. The code is widely recognized in medical genetics and is typically performed in laboratory settings.
Blue Cross Blue Shield is a primary payer covered in this analysis, reflecting the code's relevance in commercial insurance policies. Readers will gain insights into payer coverage, clinical context, and policy benchmarks for genetic testing services. The publication also highlights associated taxonomies, relevant ICD-10 diagnoses, and related CPT codes, providing a comprehensive overview for stakeholders in medical genetics and laboratory medicine.
Key topics include the clinical significance of CYP2C19 testing, payer policy trends, and coding practices for laboratory-based genetic services. This summary serves as a resource for understanding the national landscape of genetic testing reimbursement and policy updates.
CPT Code Overview
CPT code 81474 is used for genetic testing of the CYP2C19 gene, which plays a critical role in drug metabolism. This test analyzes common variants such as *2, *3, *4, *5, *6, *7, *8, and *17 to help identify how an individual may process certain medications. The service type is genetic testing, and it is typically performed in a laboratory setting (Place of Service 81). This testing provides valuable information for personalized medicine and optimizing drug therapy based on genetic factors.
Clinical & Coding Specifications
Clinical Context
A patient is referred for genetic testing to evaluate their CYP2C19 gene variants, which can impact drug metabolism. This testing is commonly ordered when a patient is being considered for medications metabolized by CYP2C19, such as certain antiplatelet drugs or antidepressants. The clinical workflow involves a healthcare provider ordering the test, a specimen (such as blood or saliva) being collected, and the laboratory performing gene analysis for common CYP2C19 variants (e.g., *2, *3, *4, *5, *6, *7, *8, *17). Results are used to inform medication selection or dosing. The service is typically performed in a laboratory setting (Place of Service 81).
Coding Specifications
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Modifiers:
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26: Used to indicate the professional component of the service, such as interpretation of the genetic test results by a qualified provider. - Modifier
TC: Used to indicate the technical component, which covers the laboratory processing and analysis of the specimen.
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Provider Taxonomies:
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