Summary & Overview
CPT 81215: BRCA1 Familial Variant Targeted Genetic Test
CPT code 81215 represents targeted laboratory testing for a known familial variant in the BRCA1 gene. It covers the technical laboratory procedure to detect a specific altered BRCA1 sequence previously identified in a family member. This code is clinically important because BRCA1 familial variant identification informs cancer risk assessment and cascade testing strategies, guiding surveillance and risk-reduction conversations. Nationally, the code is relevant for genetics laboratories, oncologists, hereditary cancer programs, and payers managing coverage for genetic services.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how the code is used clinically, typical sites of service, and payer coverage context. The publication outlines common modifiers and billing considerations, summarizes payer policy themes where available, and situates the code within clinical workflows for targeted familial variant testing. The content is intended to help billing staff, laboratory managers, and policy analysts understand where CPT code 81215 fits in genetic testing portfolios and payer interactions.
Data not available in the input for specific associated taxonomies, ICD-10 diagnosis pairings, and related codes is noted elsewhere in the publication.
Billing Code Overview
CPT code 81215 describes a laboratory test in which a lab analyst performs the technical component to detect the presence of specific altered gene sequences in the BRCA1 (DNA repair–associated) gene. The assay evaluates a specific genetic variation identified in family members of the patient, indicating targeted familial variant testing rather than broad panel or full-gene sequencing.
Service type: Targeted genetic testing (familial variant analysis)
Typical site of service: Clinical molecular laboratory or reference genetic testing laboratory
Clinical & Coding Specifications
Clinical Context
A patient with a family history of breast or ovarian cancer presents to a genetics clinic for targeted familial variant testing of the BRCA1 gene. The patient is typically an unaffected relative or an affected family member for whom a specific pathogenic or likely pathogenic BRCA1 variant has already been identified in another relative. The clinical workflow begins with pre-test genetic counseling to review family history, implications of a known familial BRCA1 variant, and informed consent for targeted testing. A blood or saliva specimen is collected in the clinic and sent to a molecular diagnostics laboratory. The laboratory performs a targeted assay to detect the specific BRCA1 sequence alteration previously reported in the family. Results are reported back to the ordering clinician and genetic counselor, who discuss implications for cancer risk management and cascade testing of relatives. Typical sites of service include outpatient genetics clinics, oncology clinics, ambulatory surgery centers for specimen collection, and commercial molecular diagnostic laboratories performing the technical analysis.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the professional interpretation by a physician/geneticist separate from the laboratory's technical component |
TC |