Summary & Overview
CPT 81476: CYP2C9 Gene Analysis for Drug Metabolism
CPT code 81476 represents genetic testing for common variants in the CYP2C9 gene, which is essential for understanding individual drug metabolism. This test is increasingly relevant as precision medicine and pharmacogenomics become central to clinical care, helping providers tailor drug therapies to patient-specific genetic profiles. The code covers analysis of variants such as *2, *3, *5, and *6, which can impact the efficacy and safety of medications.
Blue Cross Blue Shield is a key payer included in this analysis. Readers will gain insight into payer coverage, clinical indications, and policy updates related to CPT 81476. The publication also provides context on typical laboratory settings, associated diagnoses, and related genetic testing codes. Benchmarks and billing considerations are discussed to inform stakeholders about current trends and requirements for this procedure.
This summary offers a comprehensive overview of the clinical and billing landscape for CPT 81476, equipping readers with the information needed to understand its role in medical genetics and pharmacogenomics.
CPT Code Overview
CPT 81476 is used to report genetic testing for the analysis of common variants in the CYP2C9 gene. This gene plays a critical role in drug metabolism, and testing can help identify how patients may respond to certain medications. The service type is genetic testing, typically performed in a laboratory setting (POS 81). This procedure is important for guiding personalized medicine and optimizing drug therapy based on individual genetic profiles.
Clinical & Coding Specifications
Clinical Context
A patient is referred for genetic testing to evaluate their CYP2C9 gene variants, which influence drug metabolism. This is commonly performed in a laboratory setting (POS 81) when a provider needs to assess the patient's genetic susceptibility to medication effects, such as anticoagulants or other drugs metabolized by CYP2C9. The workflow typically involves a physician or geneticist ordering the test, specimen collection, and laboratory analysis of common CYP2C9 variants (e.g., *2, *3, *5, *6). Results inform medication selection or dosing, especially for patients with conditions like hypertension or hyperlipidemia who may require long-term drug therapy.
Coding Specifications
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Modifiers:
- Modifier
26: Used to indicate the professional component of the service, such as interpretation and reporting by a physician or geneticist. - Modifier
TC: Used to indicate the technical component, which covers the laboratory processing and analysis.
- Modifier
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207SG0201X | Medical Genetics, Ph.D. Medical Genetics |
207ZP0213X | Pathology, Molecular Genetic Pathology |
207Q00000X | Family Medicine Physician |
These specialties represent providers who may order, interpret, or perform the CYP2C9 genetic analysis.
Related Diagnoses
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Z13.79: Encounter for other screening for genetic and chromosomal anomalies- Used when the test is performed as a screening for genetic variants affecting drug metabolism.
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Z15.89: Genetic susceptibility to other disease- Indicates the patient has a genetic predisposition to certain diseases, relevant for pharmacogenetic testing.
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E78.5: Hyperlipidemia, unspecified- Relevant for patients on lipid-lowering medications where CYP2C9 metabolism may impact drug efficacy or safety.
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I10: Essential (primary) hypertension- Used for patients with hypertension who may require medications metabolized by CYP2C9.
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Z79.899: Other long term (current) drug therapy- Indicates ongoing drug therapy, supporting the need for pharmacogenetic testing to optimize medication management.
Related CPT Codes
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81225: CYP2C19 (cytochrome P450, family 2, subfamily C, polypeptide 19) gene analysis, common variants.- Related as another cytochrome P450 gene test for drug metabolism; may be ordered together for comprehensive pharmacogenetic profiling.
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81226: CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) gene analysis, common variants.- Related as a complementary test for drug metabolism; often used alongside
81476for broader assessment.
- Related as a complementary test for drug metabolism; often used alongside
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81479: Unlisted molecular pathology procedure.- Used when a molecular pathology procedure does not have a specific CPT code; may be an alternative if testing for rare CYP2C9 variants not covered by
81476.
- Used when a molecular pathology procedure does not have a specific CPT code; may be an alternative if testing for rare CYP2C9 variants not covered by
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81227: CYP3A4 (cytochrome P450, family 3, subfamily A, polypeptide 4) gene analysis, common variants.- Related as another cytochrome P450 gene test; may be ordered with
81476for expanded drug metabolism analysis.
- Related as another cytochrome P450 gene test; may be ordered with
These codes are commonly used together for multi-gene pharmacogenetic panels or as alternatives depending on the clinical scenario.
National Reimbursement Benchmarks
For CPT code 81476, the national mean rate for Blue Cross Blue Shield and BUCA (average commercial) is $80.02. Medicare rates are not available in the input, so a direct comparison cannot be made.
Rate dispersion for both Blue Cross Blue Shield and BUCA is extremely tight, with the 25th, 50th, and 75th percentiles all at $80.00. This indicates no variation in rates across these payers nationally. The table and chart below present the full breakdown of national benchmarks for CPT code 81476.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.