Summary & Overview
CPT 81201: APC Gene Full-Sequence Analysis
CPT code 81201 covers full sequencing of the adenomatous polyposis coli (APC) gene, a molecular diagnostic test used to detect pathogenic variants linked to familial adenomatous polyposis and related colorectal cancer risk. Nationwide, comprehensive APC sequencing informs genetic diagnosis, cancer risk assessment, and management decisions for affected patients and families, making accurate coding and coverage understanding important for laboratories and clinicians.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what CPT code 81201 represents, how it is typically delivered in laboratory settings, and which payers commonly cover the service. The publication provides benchmark context, payer coverage considerations, and the clinical context that drives utilization of full-gene APC sequencing.
The content summarizes coding specifics, typical sites of service, common modifiers (listed separately), and what to expect in reimbursement and billing workflows. Clinical implications of APC sequencing are outlined so readers understand the test's role in hereditary colorectal cancer evaluation and cascade family testing pathways. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 81201 describes full gene sequencing analysis of the adenomatous polyposis coli (APC) gene. The service involves laboratory technical procedures to determine the entire coding sequence of the APC gene to identify pathogenic variants associated with hereditary colorectal cancer syndromes.
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Service type: Clinical molecular diagnostic testing — full-gene sequencing
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Typical site of service: Clinical molecular diagnostic laboratory or reference genetic testing laboratory
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult referred by a gastroenterologist or genetic counselor after a personal or family history suggestive of familial adenomatous polyposis (FAP) or attenuated FAP. The patient presents for germline APC sequencing to detect pathogenic variants associated with multiple colorectal adenomas and early-onset colorectal cancer. The clinical workflow begins with pre-test counseling documenting indication, family history, and informed consent. A blood draw is collected in an appropriate tube and sent to a certified molecular diagnostic laboratory. The laboratory performs full-gene sequencing of the APC gene, including analysis of coding exons and flanking intronic regions, using validated next-generation sequencing or Sanger methods, with orthogonal confirmation of pathogenic or likely pathogenic variants when indicated. Results reporting includes detected variants, classification (pathogenic, likely pathogenic, variant of uncertain significance, likely benign, benign), interpretation relative to the clinical history, and recommendations for cascade testing. Turnaround time, billing (technical and professional components), and documentation of counseling and result delivery complete the workflow.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician or laboratory director interpretation/reporting portion of the test separate from the technical processing. |