Summary & Overview
CPT 81174: Targeted Androgen Receptor (AR) Gene Variant Analysis
CPT code 81174 represents a targeted molecular diagnostic test for detecting specific familial variants in the androgen receptor (AR) gene, relevant to Kennedy disease and X chromosome inactivation. This code documents the technical laboratory analysis that identifies known pathogenic or likely pathogenic AR gene changes when there is a family history or targeted clinical indication. Nationally, precise genetic testing codes like 81174 matter for clinical decision-making, variant confirmation, genetic counseling, and downstream care planning for affected individuals and at-risk family members.
Key payers commonly involved in coverage and reimbursement discussions include Aetna, Blue Cross Blue Shield plans, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and why this targeted AR gene analysis is used, plus what typical service settings look like. The publication covers coding semantics, common modifiers associated with laboratory services (listed elsewhere), and operational considerations for laboratory processing and documentation. It also highlights the role of 81174 in workflows for hereditary neuromuscular disease evaluation and cascade testing in families.
This national summary is intended to orient clinicians, laboratory managers, and billing professionals on the clinical purpose of 81174, typical sites where the testing occurs, and the payer landscape relevant to deployment and reimbursement discussions.
Billing Code Overview
CPT code 81174 describes a molecular diagnostic laboratory test performed by a lab analyst to detect specific changes in the androgen receptor (AR) gene. The assay targets known familial genetic variants associated with Kennedy disease (spinal and bulbar muscular atrophy) and patterns related to X chromosome inactivation.
Service Type: Targeted genetic molecular diagnostic testing
Typical Site of Service: Clinical molecular genetics laboratory (reference, hospital, or commercial diagnostic lab)
Clinical & Coding Specifications
Clinical Context
A 42-year-old male with progressive proximal muscle weakness, cramps, and gynecomastia is referred by a neurologist for targeted molecular testing of the androgen receptor (AR) gene to evaluate for Kennedy disease (spinal and bulbar muscular atrophy). The patient has a family history of a paternal uncle with a confirmed AR gene variant. The clinician orders a targeted AR gene variant test specifying known familial pathogenic variants. Blood or saliva is collected in clinic or at an outpatient lab and sent to a molecular diagnostics laboratory. The lab analyst performs the technical procedure to detect the specified AR gene changes using methods such as PCR sizing for CAG repeat expansions or targeted sequencing for single-nucleotide variants, generates a technical report, and transmits results to the ordering provider. Typical site of service is an outpatient clinical setting, outpatient phlebotomy center, or a commercial molecular diagnostics laboratory. Billing reflects the laboratory technical component; a separate professional component may be billed by the interpreting laboratory director if applicable.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (default) | Use when no special circumstances apply and full service is provided |
26 |