Summary & Overview
CPT 81226: CYP2D6 Genetic Variant Detection
CPT code 81226 represents molecular laboratory testing to detect common genetic changes in the CYP2D6 gene, a key enzyme in drug metabolism. Nationally, CYP2D6 testing informs pharmacogenomic-guided prescribing across multiple therapeutic areas, making this code relevant for precision medicine programs and outpatient laboratory services. The code covers the technical laboratory component of detecting CYP2D6 variants.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for CYP2D6 testing, the typical service setting, and payer relevance. The publication summarizes benchmark considerations for coverage and utilization, highlights policy and coding updates affecting laboratory reporting, and outlines implications for laboratory and clinical workflows. Practical information includes service line placement and typical sites of service for this technical molecular assay.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes. The content is intended to inform coding, billing, and policy stakeholders about the clinical purpose and payer landscape for CPT code 81226 at a national level.
Billing Code Overview
CPT code 81226 describes a laboratory test performed by a lab analyst to detect common genetic variants in the CYP2D6 gene (cytochrome P450, family 2, subfamily D, polypeptide 6). This test identifies alterations that can affect drug metabolism, supporting medication selection and dosing decisions in clinical care.
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Service type: Clinical diagnostic molecular laboratory testing
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Typical site of service: Clinical diagnostic laboratory or outpatient laboratory facility
Clinical & Coding Specifications
Clinical Context
A 45-year-old patient with a history of chronic depression and prior inadequate response to selective serotonin reuptake inhibitors (SSRIs) is referred for pharmacogenetic testing to guide medication selection. The ordering clinician—commonly a psychiatrist, primary care physician, or clinical pharmacologist—requests genotyping of the cytochrome P450 2D6 gene to detect common variant alleles that affect drug metabolism. A phlebotomy or buccal swab specimen is collected in an outpatient clinic or ambulatory laboratory; the specimen is sent to a molecular diagnostics laboratory where a clinical laboratory scientist performs 81226 testing using validated genotyping methods. Results are reported back to the ordering provider and incorporated into medication management decisions, typically alongside clinical interpretation reporting metabolizer status (e.g., poor, intermediate, normal, ultrarapid). Typical sites of service include independent clinical diagnostic laboratories, hospital-based molecular pathology labs, and outpatient ambulatory care centers that collect specimens for send-out testing. The workflow includes order entry, specimen collection and accessioning, DNA extraction, targeted genotyping for common CYP2D6 variants, analytical verification, and result reporting with phenotype interpretation for medications metabolized by CYP2D6 such as certain antidepressants, antipsychotics, beta-blockers, and opioids.
Coding Specifications
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