Summary & Overview
CPT 81230: CYP3A4 Variant Analysis, Technical Laboratory Test
CPT code 81230 covers the technical laboratory analysis of common variants in the CYP3A4 gene, such as *2 and *22. This pharmacogenomic test identifies inherited variants that affect drug metabolism for medications metabolized by CYP3A4, with implications for personalized medication selection and dosing. Nationally, genetic testing for drug metabolism has grown in clinical and commercial contexts as precision prescribing expands.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage and coding policies vary by payer; Medicare policies focus on clinical utility and medical necessity, while commercial plans evaluate evidence for pharmacogenomic testing and may apply benefit-specific criteria.
Readers will learn the clinical purpose and laboratory setting for CPT code 81230, the primary payers relevant to national coverage considerations, and what information is typically included in a code-level brief: the service type (molecular diagnostic technical component), typical site of service (clinical/molecular laboratory), and areas where input data are unavailable. The publication also summarizes where additional details are needed, such as explicit payer policy language, associated taxonomies, ICD-10 diagnoses, and related procedure codes. Data not available in the input will be noted where relevant.
Billing Code Overview
CPT code 81230 describes laboratory testing for common variants of the cytochrome P450 family 3 subfamily A member 4 gene (CYP3A4), including variants such as *2 and *22. The service reflects the technical laboratory analysis that detects these genetic variants to inform medication metabolism and pharmacogenomic interpretation.
Service Type: Molecular diagnostic / genetic testing (technical component)
Typical Site of Service: Clinical laboratory or commercial molecular diagnostics laboratory
Clinical & Coding Specifications
Clinical Context
A 52-year-old outpatient referred by a primary care physician or clinical pharmacologist for pharmacogenetic testing due to unexpected adverse drug effects or inadequate response to medications metabolized by the CYP3A4 enzyme (for example, certain statins, calcium channel blockers, benzodiazepines, some immunosuppressants, and some chemotherapeutic agents). The clinician documents a history of abnormal drug tolerance or therapeutic failure despite standard dosing and requests genotype analysis for CYP3A4 common variants such as *2 and *22 to guide medication selection or dosing.
The clinical workflow: a clinician orders the test in the electronic medical record and obtains informed consent if required. A blood or saliva sample is collected at an ambulatory clinic, specialty practice, or hospital outpatient phlebotomy service. The specimen is sent to a molecular diagnostics laboratory where a lab analyst performs the technical assay corresponding to CPT 81230 to detect CYP3A4 variants. The laboratory generates a technical report and, if applicable, a separate interpretive/professional consult is provided by a molecular pathologist or clinical pharmacologist billed separately if performed. Results are returned to the ordering provider to inform medication selection, dosing adjustments, or further pharmacogenetic counseling in outpatient follow-up.
Coding Specifications
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