Summary & Overview
CPT 81236: EZH2 Gene Full Coding Sequence Analysis
CPT code 81236 represents full-gene sequencing of the EZH2 gene, a molecular diagnostic procedure used to identify sequence variants across the entire coding region. Nationally, this code matters because comprehensive gene sequencing informs targeted oncology care, genetic counseling, and precision medicine strategies where EZH2 alterations are clinically relevant. Payers commonly covering analyses in this space include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. This publication summarizes clinical context for the test, payer coverage patterns, and operational benchmarks relevant to laboratory and billing teams. Readers will find: an explanation of the clinical purpose of full EZH2 sequencing; the typical sites of service and how the service is billed; common modifiers and coding practices (listed elsewhere in the document); and benchmark metrics and policy updates that affect coverage and reimbursement. Where specific payer policies or data are not provided in the input, the document notes that data are not available in the input. The content is intended for a national audience of laboratory managers, billing professionals, and policy analysts seeking concise guidance on the billing and clinical role of CPT code 81236.
Billing Code Overview
CPT code 81236 describes sequencing of the entire gene coding sequence for the enhancer of zeste 2 polycomb repressive complex 2 subunit gene (EZH2). This service is a molecular diagnostic laboratory test that analyzes the full gene sequence to detect variants in the EZH2 gene.
Service Type: Clinical molecular laboratory — full gene sequencing
Typical Site of Service: Clinical laboratory or reference molecular diagnostics laboratory
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a history of follicular lymphoma presents with clinical progression after initial therapy. The treating hematologist-oncologist orders comprehensive tumor genomic profiling to evaluate for actionable somatic variants, including sequencing of the enhancer of zeste 2 polycomb repressive complex 2 subunit gene. A peripheral blood or bone marrow specimen is collected and sent to a CLIA-certified molecular diagnostics laboratory. The lab analyst performs full-gene sequencing of the EZH2 coding region and relevant intronic boundaries to detect single nucleotide variants, small insertions and deletions, and other sequence-level alterations. Results are interpreted by a molecular pathologist and reported to the ordering provider to inform prognosis and potential eligibility for targeted therapies or clinical trials. Typical site of service: hospital outpatient laboratory or independent molecular diagnostic reference laboratory.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing for the professional interpretation/reporting component separate from the technical lab work if split billing is permitted. |
TC |