CPT 81206: BCR/ABL1 Major Breakpoint Molecular Test
CPT code 81206 identifies molecular testing for the BCR/ABL1 major breakpoint fusion gene, a clinically important marker in hematologic malignancies such as chronic myeloid leukemia and some acute leukemias. This test can be reported as a qualitative assay to detect the presence of the fusion or as a quantitative assay to measure transcript levels, and it informs diagnosis, monitoring of disease burden, and treatment response nationally. The code represents a specialized laboratory service performed by trained molecular pathology personnel using nucleic acid-based methods.
Key payers discussed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise presentation of clinical context, typical sites of service, and the role of this test in patient management. The publication also outlines payer coverage considerations, common modifiers encountered, and related administrative details where available. Benchmarks and policy updates are summarized to aid billing and compliance staff in understanding reimbursement and documentation expectations. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 81206 describes molecular diagnostic testing for the BCR/ABL1 major breakpoint fusion gene on chromosome 22. The procedure evaluates breakage and reformation of the altered gene sequence and can be performed as a qualitative assay (detecting presence of the fusion gene) or a quantitative assay (measuring the amount of each fusion transcript).
Service Type: Molecular pathology / molecular diagnostic testing
Typical Site of Service: Clinical laboratory or hospital molecular diagnostics laboratory