CPT 81216 BRCA2 Full-Gene Sequencing Reimbursement

CPT code 81216 represents full-gene sequencing of the BRCA2 gene, a molecular diagnostic test used to detect germline variants associated with hereditary breast and ovarian cancer. Nationally, this code is central to genetic risk assessment, informing clinical management, family counseling, and eligibility for targeted therapies and surveillance programs. Coverage and utilization of BRCA2 sequencing affect access to precision oncology and preventive care across payers.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for BRCA2 sequencing, typical sites of service, and the role of this test in diagnostic and preventive pathways. The publication outlines common billing and coding considerations, typical modifiers encountered, and where CPT code 81216 sits relative to other molecular genetic services.

The report summarizes benchmarking and coverage themes relevant to national payers, highlights policy features that influence reimbursement and access, and provides operational context for laboratory and billing teams. Data limitations: specific taxonomies, ICD-10 pairings, and related codes are not included here and are noted as not available in the input.

Billing Code Overview

CPT code 81216 describes a laboratory service that performs full-gene sequencing of the BRCA2, DNA repair–associated gene (BRCA2). The service is a molecular diagnostic genetic test that analyzes the entire coding sequence of the BRCA2 gene to identify sequence variants associated with hereditary cancer risk.

Service Type: Genetic sequencing / molecular diagnostic test

Typical Site of Service: Clinical molecular diagnostics laboratory or reference laboratory

Data not available in the input.

Clinical Context

A 42-year-old woman with a family history of breast and ovarian cancer is referred to a clinical genetics laboratory after genetic counseling. She reports a first-degree relative with confirmed pathogenic BRCA2 variant. The ordering clinician documents personal concern for hereditary breast and ovarian cancer syndrome and requests comprehensive BRCA2 gene sequencing. A phlebotomy encounter is scheduled at an outpatient laboratory; blood is collected, accessioned, DNA is extracted, and the laboratory performs full-sequence analysis of the BRCA2 gene to detect single nucleotide variants, small insertions and deletions, and likely pathogenic or pathogenic variants. The laboratory issues a report with identified variants and clinical interpretation for the ordering provider. Typical site of service: outpatient ambulatory laboratory or hospital clinical molecular genetics laboratory. Service type: molecular diagnostic, full gene sequencing (technical laboratory analysis).

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the professional (interpretation) component of the test if separated from the technical component.
`TC`	Technical component

Taxonomy Code	Specialty	Notes
207RG0200X	Clinical Molecular Genetics	Laboratory directors and molecular geneticists who oversee sequencing and variant interpretation.
207RH0000X	Molecular Genetic Pathology	Pathologists with molecular diagnostics focus providing interpretation and sign-out.
363L00000X	Phlebotomist	Professionals performing specimen collection in ambulatory or inpatient settings.
208D00000X	Medical Genetics	Medical geneticists who order testing and incorporate results into clinical care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z15.01`	Genetic susceptibility to malignant neoplasm of breast	Indicates documented family history or known genetic predisposition prompting BRCA2 sequencing.
`Z15.02`	Genetic susceptibility to malignant neoplasm of ovary	Used when ovarian cancer risk is the indication for BRCA2 testing.
`Z80.3`	Family history of malignant neoplasm of breast	Common reason to order BRCA2 sequencing when a close relative has breast cancer.
`Z80.41`	Family history of malignant neoplasm of ovary	Used to document family history that supports hereditary testing.
`C50.919`	Malignant neoplasm of unspecified site of unspecified female breast	Personal history of breast cancer can prompt BRCA2 testing for treatment and recurrence risk.
`Z85.3`	Personal history of malignant neoplasm of breast	Documented prior breast cancer in the patient supports germline testing for BRCA2.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`81162`	BRCA1 and BRCA2, common known familial variants, targeted testing	Performed when a known familial BRCA2 variant exists and targeted testing for that variant is requested instead of full sequencing.
`81432`	Oncology (hereditary) multigene panel for susceptibility to malignant neoplasm (e.g., breast/ovarian)	May be ordered when broader hereditary cancer panel testing is indicated alongside or instead of single-gene BRCA2 sequencing.
`G0452`	Laboratory test for hereditary BRCA1/BRCA2 sequencing (carrier screening) — HCPCS (when applicable)	Used in some payer contexts for lab reporting or bundling; relates as an alternative or adjunct billing path in certain programs.
`81161`	BRCA1, full gene sequence analysis	Performed in tandem when both BRCA1 and BRCA2 full sequencing are ordered for hereditary cancer assessment.
`81215`	BRCA1, DNA repair–associated, full gene sequence analysis	Closely related; often ordered together with `81216` when assessing hereditary breast/ovarian cancer risk.

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Summary & Overview

CPT 81216: BRCA2 Full-Gene Sequencing