CPT 81219 CALR Exon 9 Variant Analysis Reimbursement

CPT code 81219 represents the technical laboratory analysis for common exon 9 variants in the CALR (calreticulin) gene, a molecular diagnostic assay used in evaluating myeloproliferative neoplasms and related hematologic conditions. This gene-specific test matters nationally because CALR exon 9 mutations are clinically significant biomarkers that can influence diagnosis, risk stratification, and potential therapeutic decision-making. Molecular testing volume and coverage policy for such assays affect clinical workflows, lab reimbursement, and access to precision diagnostics across the country.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what CPT code 81219 covers, typical sites of service, and the clinical context for testing. The publication provides benchmarks and policy-relevant notes about payer coverage frameworks, billing practice considerations, and coding relationships that commonly arise with molecular diagnostic services. Data not available in the input are noted where relevant.

This summary is intended for laboratory directors, coding and billing staff, policy analysts, and clinicians who need a focused briefing on the clinical purpose and payer landscape surrounding CPT code 81219.

Billing Code Overview

CPT code 81219 describes laboratory analysis for common exon 9 variants in the CALR (calreticulin) gene. The service represents the technical laboratory testing performed by a lab analyst to detect somatic or germline variants located in exon 9 of the CALR gene.

Service Type: Molecular diagnostic / Genetic testing (technical component)

Typical Site of Service: Clinical laboratory or independent diagnostic testing facility (IDTF)

Clinical Context

A 62-year-old patient with persistent thrombocytosis and anemia is evaluated by a hematologist for suspected myeloproliferative neoplasm (MPN). Peripheral blood testing has excluded a JAK2 V617F mutation and MPL exon 10 mutations; the clinician orders molecular testing of the CALR gene to detect exon 9 variants that are commonly associated with essential thrombocythemia and primary myelofibrosis. A venous blood sample (EDTA) is collected in the outpatient phlebotomy clinic and sent to a reference molecular diagnostics laboratory. In the lab, a molecular technologist performs the technical testing workflow that may include DNA extraction, PCR amplification of CALR exon 9, fragment analysis or sequencing to detect insertions/deletions, quality control, and generation of a technical report. The laboratory issues a results report to the ordering hematologist; the professional component (interpretation and physician sign-out) may be billed separately by the pathologist or molecular geneticist using the appropriate professional component modifier.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when the physician or pathologist performs interpretive services and signs the report separate from the laboratory technical component.
`TC`

Taxonomy Code	Specialty	Notes
2080P0200X	Hematology	Hematologists order and interpret CALR testing for myeloproliferative disorders.
2085P0208X	Molecular Pathology	Molecular pathologists oversee and interpret molecular diagnostics including CALR sequencing.
208000000X	Clinical Laboratory	Clinical laboratory directors/CLIA supervisors manage technical testing workflows.
207K00000X	Allergy & Immunology (Laboratory oversight)	Some immunohematology labs with molecular sections may include this taxonomy for oversight.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`D75.9`	Hematologic disorder, unspecified	Used when a specific myeloproliferative diagnosis is pending and CALR testing is part of the diagnostic evaluation.
`D47.3`	Essential (primary) thrombocythemia	CALR exon 9 variants are driver mutations in a substantial subset of patients with essential thrombocythemia; testing helps confirm molecular diagnosis.
`D47.4`	Osteomyelofibrosis (primary myelofibrosis)	CALR mutations are relevant to risk stratification and diagnosis in primary myelofibrosis.
`R70.0`	Elevated erythrocyte sedimentation rate (ESR)	Non-specific inflammatory marker that may accompany hematologic workup; included when inflammatory signs prompt hematology evaluation.
`D69.6`	Thrombocythemia, unspecified	When thrombocytosis is documented and molecular testing for CALR is ordered to define etiology.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`81219`	CALR (calreticulin) gene; common exon 9 variants (e.g., type 1, type 2) — technical component described in this code	Primary molecular test performed to detect exon 9 CALR insertions/deletions associated with MPNs; typically represents the technical laboratory assay when billed by the performing lab.
`81305`	BCR/ABL1 (Philadelphia chromosome) detection by molecular methods; quantitative or qualitative	Often part of a comprehensive MPN/myeloid workup to exclude BCR-ABL1–positive chronic myeloid leukemia when presenting with leukocytosis or splenomegaly.
`81275`	JAK2 (Janus kinase 2) gene, somatic mutation analysis (e.g., V617F)	Frequently ordered alongside CALR testing because JAK2 mutations are common in MPN differential diagnosis; performed before or concurrent with CALR testing.
`81276`	MPL (myeloproliferative leukemia) gene, exon 10 variants	Ordered in the diagnostic algorithm for MPNs if JAK2 is negative; complements `81219` to establish driver mutation status.
`88363`	Morphometric analysis/interpretation of bone marrow biopsy (morphology and cellularity)	Bone marrow biopsy interpretation and ancillary studies often accompany molecular testing to establish a diagnosis of essential thrombocythemia or primary myelofibrosis.

OpenPayer

Summary & Overview

CPT 81219: CALR Exon 9 Variant Analysis, Technical Laboratory Test