CPT 81232 DPYD Variant Analysis Reimbursement

CPT code 81232 identifies a molecular diagnostic laboratory procedure that analyzes common dihydropyrimidine dehydrogenase (DPYD) gene variants such as *2A, *4, *5, and *6. DPYD testing informs potential toxicity risk for fluoropyrimidine chemotherapy and has national clinical relevance for precision oncology and medication safety. This code represents the technical laboratory component of targeted DPYD variant analysis performed by clinical molecular diagnostics laboratories.

Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context, coding definition, typical sites of service, and payer scope. The publication outlines expected billing considerations, common modifiers, and typical use cases in oncology and pharmacogenetic counseling. It also highlights benchmarking and policy observations where available and notes when input data are not provided.

This summary serves clinicians, laboratory billing staff, and policy analysts seeking a concise reference on CPT code 81232, its clinical application, and the payer landscape relevant to DPYD variant testing at a national level.

Billing Code Overview

CPT code 81232 describes a laboratory test analyzing common variants of the dihydropyrimidine dehydrogenase (DPYD) gene, including variants such as *2A, *4, *5, and *6. The procedure covers the technical laboratory analysis performed by a lab analyst to detect these clinically relevant DPYD gene variants.

Service type: Genetic molecular diagnostic test (DPYD variant analysis)

Typical site of service: Clinical laboratory or molecular diagnostics laboratory

Clinical Context

A 56-year-old patient with metastatic colorectal cancer is being considered for fluoropyrimidine chemotherapy (e.g., 5-fluorouracil or capecitabine). Prior to initiating therapy, the oncology team orders genetic testing to identify common clinically relevant variants of the dihydropyrimidine dehydrogenase gene to assess risk for severe toxicity. A blood sample is collected in the oncology clinic or outpatient phlebotomy lab and sent to a molecular diagnostics laboratory. The lab analyst performs the technical assay described by 81232, analyzing DPYD variants such as *2A, *4, *5, and *6. Results are reported to the ordering oncologist and entered into the electronic health record; the physician interprets results and documents any chemotherapy dose modifications or alternative regimen selection in the treatment plan.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing separately for the interpretive/professional component if applicable and reportable for the testing service.

Taxonomy Code	Specialty	Notes
207RG0100X	Hematology & Oncology	Oncologists order DPYD testing to assess chemotherapy risk and adjust dosing.
363L00000X	Diagnostic Molecular Pathology	Molecular pathologists and laboratory directors oversee analytic validation and interpretation of DPYD variant testing.
207LN0001X	Medical Oncology	Medical oncologists integrate results into systemic therapy planning and consent discussions.
208D00000X	Pathology	Anatomic and clinical pathologists may manage lab operations and result sign-out for molecular assays.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C18.9`	Malignant neoplasm of colon, unspecified	Colorectal cancer is a primary indication for fluoropyrimidine-based chemotherapy and DPYD testing prior to therapy.
`C20`	Malignant neoplasm of rectum	Rectal cancer patients receiving 5-FU or capecitabine are evaluated with DPYD testing to mitigate toxicity risk.
`C78.7`	Secondary malignant neoplasm of liver and intrahepatic bile duct	Metastatic disease often prompts systemic fluoropyrimidine therapy and concurrent DPYD testing.
`Z15.09`	Genetic susceptibility to other malignant neoplasm	Used when documenting known genetic susceptibility that informs treatment planning and testing decisions.
`Z13.79`	Encounter for screening for other genetic and chromosomal anomalies	May be used to indicate a screening genetic test encounter including pharmacogenomic testing like DPYD.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`81225`	Analysis of TPMT (thiopurine methyltransferase) gene variants	Another pharmacogenomic test sometimes ordered to assess risk for thiopurine toxicity when tailoring chemotherapy or supportive care.
`81234`	Analysis of other DPYD variants by sequencing methods	May be ordered when a broader or sequencing-based DPYD analysis is required beyond common targeted variants covered by `81232`.
`81162`	Whole gene or targeted sequence analysis, single gene (e.g., targeted sequencing)	Used when a comprehensive sequencing approach of `DPYD` or other chemosensitivity genes is performed; complements targeted genotyping.
`81025`	Urine pregnancy test, performed in lab	Often performed prior to initiation of cytotoxic chemotherapy in women of childbearing potential as part of pre-treatment testing.
`80053`	Comprehensive metabolic panel	Routine baseline labs frequently ordered before chemotherapy initiation and may be co-billed during the same episode of care.

OpenPayer

Summary & Overview

CPT 81232: DPYD Variant Analysis, Targeted Molecular Test