CPT 81217 BRCA2 Familial Variant Reimbursement

CPT code 81217 represents a targeted molecular diagnostic test for a specific familial variant in the BRCA2 gene. This test confirms whether a patient carries a BRCA2 alteration previously identified in a family member and is widely used in hereditary cancer risk assessment, cascade testing, and genetic counseling follow-up. Nationally, availability of targeted familial testing supports precision prevention strategies and can influence clinical decision-making for cancer surveillance, risk-reducing options, and family planning.

Key payers considered in coverage and utilization discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for targeted BRCA2 familial variant testing, typical sites of service, and the kinds of benchmarks and policy updates that affect coverage and billing practice. The publication summarizes payer coverage trends, common billing modifiers encountered, and operational considerations for laboratory and clinical teams handling targeted hereditary cancer testing.

This report is intended to inform laboratory administrators, genetic counselors, and billing professionals about the coding purpose and clinical role of CPT code 81217, how it fits into hereditary cancer testing pathways, and what topics to monitor in payer policy and laboratory practice. Data not available in the input is noted where applicable.

Billing Code Overview

CPT code 81217 describes a targeted genetic test that detects a specific altered gene sequence in the BRCA2 (BRCA2, DNA repair–associated) gene previously identified in a family member. The service is a molecular diagnostic test focused on confirming a known familial BRCA2 variant in the patient.

Service type: Targeted germline DNA sequencing / mutation analysis

Typical site of service: Clinical molecular laboratory or medical genetics laboratory performing diagnostic testing for hereditary cancer risk.

Clinical Context

A 38-year-old woman with a strong family history of breast and ovarian cancer presents to a genetics clinic requesting targeted familial BRCA2 testing after a known pathogenic BRCA2 variant was documented in an affected relative. The clinical workflow begins with a genetic counseling visit to review family history and the previously identified familial BRCA2 variant. After informed consent, a blood sample is collected and sent to a molecular diagnostics laboratory. The laboratory performs targeted technical testing to detect the presence or absence of the specific BRCA2 sequence alteration identified in the family (single-site or known-variant analysis). The laboratory issues a technical report indicating whether the variant is detected, not detected, or inconclusive; results are routed back to the ordering genetics provider for interpretation, follow-up counseling, and management planning.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the professional (interpretation) portion and the lab bills separately for the technical component.
`TC`	Technical component	Use when billing only the technical component (laboratory testing) of .

Taxonomy Code	Specialty	Notes
208D00000X	Medical Genetics	Physicians who order, interpret, and provide follow-up for familial BRCA2 testing.
207Q00000X	Clinical Laboratory	Laboratory directors and personnel performing molecular diagnostics and reporting technical results.
208000000X	Hematology & Oncology	Medical oncologists who may use hereditary BRCA2 results for treatment planning.
363L00000X	Genetic Counselor	Board-certified genetic counselors who perform pre- and post-test counseling and consent.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z15.01`	Genetic susceptibility to malignant neoplasm of breast	Indicates a personal or family risk for hereditary breast cancer prompting targeted BRCA2 familial variant testing.
`Z15.02`	Genetic susceptibility to malignant neoplasm of ovary	Used when family history suggests hereditary ovarian cancer risk related to BRCA2 variants.
`Z80.3`	Family history of malignant neoplasm of breast	Family history code supporting the medical necessity of single-site familial BRCA2 testing.
`Z80.41`	Family history of malignant neoplasm of ovary	Supports targeted testing when an affected relative had ovarian cancer and a known BRCA2 variant.
`Z84.81`	Family history of carrier of genetic disease	Use when a family member is a known carrier of a specific BRCA2 pathogenic variant and testing is requested to determine carrier status.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`81217`	BRCA2 (DNA repair–associated) known familial variant analysis	Primary targeted molecular test performed to determine presence/absence of a specific familial BRCA2 alteration.
`81211`	BRCA1 (DNA repair–associated) known familial variant analysis	Performed when a known familial BRCA1 variant is being assessed; commonly ordered in parallel if family history includes BRCA1.
`81162`	Molecular pathology sequencing, interpretation and report (selected target analysis)	Used for targeted single-site or variant-specific sequencing workflows and interpretation components that may accompany `81217`.
`81432`	Pharmacogenomic or hereditary cancer panel sequencing (example hereditary breast cancer panels)	Broader multi-gene panel testing performed before or instead of single-site testing when no known familial variant is available.
`88384`	Immunohistochemistry consultation and interpretation	May be used in the diagnostic pathway for tumor testing to identify candidates for germline BRCA testing when tumor features suggest hereditary cancer.

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Summary & Overview

CPT 81217: Targeted BRCA2 Familial Variant Testing