Summary & Overview
CPT 81212: Targeted BRCA1 and BRCA2 Variant Detection
CPT code 81212 represents a targeted molecular diagnostic test that detects three specific pathogenic variants in the BRCA1 and BRCA2 genes (185delAG, 5385insC, 6174delT). This focused assay is used in clinical laboratories to identify well-characterized, high-impact alterations associated with hereditary breast and ovarian cancer risk. Nationally, BRCA variant testing informs patient risk assessment, clinical management decisions, and access to genetic counseling and targeted therapies, making accurate coding and coverage determinations important for clinicians, laboratories, and payers.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides readers with a concise overview of CPT code 81212, expected service characteristics, and the clinical context for targeted BRCA1/BRCA2 variant testing. Readers will find benchmarks for utilization and coverage frameworks, summaries of relevant policy considerations for laboratory reimbursement, and clinical context that explains when targeted variant assays are used versus broader sequencing approaches. Data limitations and missing fields are noted where input information was not provided.
Billing Code Overview
CPT code 81212 describes a laboratory molecular test that detects specific pathogenic variants in the BRCA1 and BRCA2 genes (variants: 185delAG, 5385insC, 6174delT). The service is a genetic diagnostic assay performed by a laboratory analyst and focuses on targeted detection of those defined gene changes.
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Service type: Targeted molecular genetic testing for specific BRCA1/BRCA2 variants
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Typical site of service: Clinical laboratory or reference lab performing molecular diagnostics
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 38-year-old woman with a strong family history of breast and ovarian cancer is referred by her genetic counselor for targeted BRCA founder mutation testing. The specimen (peripheral blood) is collected at an outpatient phlebotomy lab or hospital ambulatory clinic and sent to the molecular diagnostics laboratory. The laboratory analyst performs technical testing for the three specified founder variants in the BRCA1 and BRCA2 genes (185delAG, 5385insC, 6174delT) to determine presence or absence of these pathogenic changes. Results are returned to the ordering clinician and genetic counselor for interpretation, patient counseling, and management planning. Typical workflow steps: specimen collection, test requisition with clinical indication, sample accessioning, DNA extraction, targeted variant analysis, result validation and reporting, and electronic transmission of the report to the ordering provider.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation component separately from the technical lab component when applicable. |