Summary & Overview
CPT 81165: BRCA1 Full-Gene Sequencing Technical Service
CPT code 81165 represents the technical laboratory service for sequencing and analyzing the entire BRCA1 gene. As a molecular diagnostic test used in hereditary cancer risk assessment, this code underpins clinical decision-making for patients and impacts payer coverage and lab reimbursement nationally. It matters because BRCA1 sequencing identifies pathogenic variants associated with increased risks for breast, ovarian, and other cancers, informing risk management and therapeutic choices.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for BRCA1 full-gene sequencing, how the service is typically delivered in laboratory settings, and the typical sites of service. The publication also provides benchmarking context on utilization and payment where available, summaries of relevant policy considerations from major payers, and coding relationships that affect billing and claim adjudication.
The content is organized to help laboratory managers, billing professionals, and policy analysts understand the role of CPT code 81165 in molecular diagnostics workflows, payer coverage patterns, and areas where policy updates or coding nuances commonly arise. Data not provided in the input is noted where applicable.
Billing Code Overview
CPT code 81165 describes a laboratory technical service that performs sequencing and analysis of the entire gene sequence for the BRCA1 DNA repair–associated gene (BRCA1). The code captures the technical component of a full-gene sequencing test used to detect sequence variants in BRCA1 that may be relevant to inherited cancer risk.
Service Type: Clinical laboratory genetic testing — full gene sequencing (BRCA1)
Typical Site of Service: Clinical laboratory or reference molecular diagnostics laboratory
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 38-year-old woman with a strong family history of breast and ovarian cancer presents to a genetic counseling clinic for hereditary cancer risk assessment. After counseling and informed consent, a peripheral blood sample is collected and sent to a molecular diagnostics laboratory. The laboratory performs comprehensive sequencing of the entire BRCA1 gene, including analysis for single-nucleotide variants and small insertions/deletions across coding regions and splice junctions. Results are reported to the ordering clinician and genetic counselor, who integrate pathogenic or likely pathogenic findings into risk management planning. Typical clinical workflow includes: pre-test counseling, specimen collection at an outpatient phlebotomy site, shipment to a CLIA-certified molecular lab, performance of the technical sequencing and variant detection (the activity described by 81165), validation and interpretation by laboratory specialists, and transmission of results to the ordering provider. Typical site of service: outpatient laboratory or hospital-based molecular pathology lab. Typical patient scenario: adult with personal or family history suggestive of hereditary breast/ovarian cancer undergoing diagnostic germline BRCA1 sequencing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting the interpretation or professional component separately from the technical lab work if applicable in hybrid billing situations. |