Summary & Overview
CPT 81477: Molecular Pathology Procedure, Level 9 DNA Sequence Analysis
CPT code 81477 is a high-complexity molecular pathology procedure used for DNA sequence analysis of 11-25 exons within a single gene. This code is significant in the national landscape of laboratory medicine, as it enables precise genetic testing for a range of clinical indications, including cancer diagnostics, hereditary disease risk assessment, and targeted screening for genetic anomalies. The procedure is typically performed in specialized laboratory settings and is integral to advancing personalized medicine and improving patient outcomes.
The publication provides a comprehensive overview of 81477, including its clinical context, typical site of service, and associated billing practices. Key payer coverage is highlighted, with Blue Cross Blue Shield as a primary example. Readers will gain insights into relevant benchmarks, policy updates, and the role of this code in modern pathology and laboratory workflows. The summary also addresses common modifiers and related codes, offering clarity on how 81477 fits within broader molecular testing panels and reimbursement structures. This resource is designed for healthcare professionals, billing specialists, and policy analysts seeking up-to-date information on advanced molecular pathology procedures.
CPT Code Overview
CPT code 81477 represents a molecular pathology procedure, Level 9, which typically involves the analysis of 11-25 exons in a single gene by DNA sequence analysis. This code is used within the Pathology and Laboratory service type and is most commonly performed in a laboratory setting, designated as Place of Service 81. The procedure is essential for advanced genetic testing, supporting clinical decision-making in areas such as oncology, hereditary disease screening, and personalized medicine.
Clinical & Coding Specifications
Clinical Context
A patient presents to their physician with a personal or family history of cancer, such as breast cancer, or is undergoing screening for genetic and chromosomal anomalies. The physician orders a molecular pathology procedure to analyze 11-25 exons in a single gene by DNA sequence analysis, which is performed in a laboratory setting (Place of Service 81). The results help guide diagnosis, prognosis, or treatment decisions, particularly in cases of suspected or confirmed malignancy or genetic disease. The workflow involves specimen collection, laboratory analysis, and interpretation by a pathologist or clinical laboratory specialist.
Coding Specifications
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Modifiers:
- Modifier
26: Used to indicate the professional component of the service, typically when the provider is only interpreting the results and not performing the technical laboratory work. - Modifier
59: Used to denote a distinct procedural service, indicating that the procedure is separate from other services performed on the same day.
- Modifier
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207ZP0102X | Clinical Pathology/Laboratory Medicine |
207L00000X | Anatomic Pathology |
207Q00000X | Family Medicine Physician |
These taxonomies represent providers who may order, perform, or interpret molecular pathology procedures, including pathologists and family medicine physicians.
Related Diagnoses
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C80.1: Malignant (primary) neoplasm, unspecified- Relevant for patients with a diagnosis of cancer where the primary site is not specified, supporting the need for molecular analysis.
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Z85.3: Personal history of malignant neoplasm of breast- Indicates a patient with a history of breast cancer, often warranting genetic testing for recurrence risk or treatment planning.
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Z84.81: Family history of carrier of genetic disease- Used when there is a family history of genetic disease, supporting the rationale for molecular pathology testing.
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Z13.79: Encounter for other screening for genetic and chromosomal anomalies- Applied when the patient is undergoing screening for genetic or chromosomal anomalies, justifying the use of molecular pathology procedures.
Related CPT Codes
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81479: Unlisted molecular pathology procedure- Used when a molecular pathology procedure does not have a specific CPT code. May be used as an alternative to
81477for unique or uncommon tests.
- Used when a molecular pathology procedure does not have a specific CPT code. May be used as an alternative to
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81225: CYP2C19 gene analysis- Specific gene analysis for CYP2C19. May be ordered alongside
81477if multiple genes are being analyzed.
- Specific gene analysis for CYP2C19. May be ordered alongside
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81235: EGFR gene analysis- Analysis of the EGFR gene, often relevant in cancer diagnostics. Can be used in conjunction with
81477for comprehensive genetic profiling.
- Analysis of the EGFR gene, often relevant in cancer diagnostics. Can be used in conjunction with
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81445: Targeted genomic sequence analysis panel, solid organ neoplasm- Panel-based testing for solid organ neoplasms. May be used as an alternative or complement to
81477when broader genomic analysis is required.
- Panel-based testing for solid organ neoplasms. May be used as an alternative or complement to
Codes 81225, 81235, and 81445 are commonly used together with or as alternatives to 81477 depending on the clinical scenario and the genes being analyzed.
National Reimbursement Benchmarks
Nationally, Blue Cross Blue Shield and BUCA (average commercial) both reimburse CPT code 81477 at a mean rate of $80.02. No data is available for Medicare, Aetna, Cigna, or UnitedHealthcare for this code.
Rate dispersion for Blue Cross Blue Shield and BUCA is minimal, with the 25th, 50th, and 75th percentiles all at $80.00, indicating a very tight range and no variation across providers. This suggests consistent reimbursement rates for this code among commercial payers with available data.
The table and chart below present the full breakdown of national mean rates and percentile values for each payer.
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.