Summary & Overview
CPT 81240: Prothrombin (F2) Gene Variant Testing
CPT code 81240 designates a laboratory molecular diagnostic test for common sequence changes in the prothrombin (F2) gene. This genetic assay is clinically relevant for assessing inherited or acquired risk factors for altered coagulation and can inform perioperative planning, thrombosis risk assessment, and family risk discussions. Nationally, molecular diagnostic codes such as 81240 are important for laboratory reimbursement, clinical reporting consistency, and integration of genetic findings into care pathways.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical context, typical sites of service, common billing considerations, and payer coverage landscape. The publication summarizes benchmark payment patterns and reimbursement policy updates where available, and outlines operational considerations for laboratories and clinicians submitting claims for this service.
The content provides actionable reference material on code definition and usage, payer coverage trends, and areas where policy clarification commonly arises for molecular diagnostic testing. Data not available in the input will be identified where relevant.
Billing Code Overview
CPT code 81240 reports a laboratory molecular test that detects common sequence changes in the prothrombin (coagulation factor II, F2) gene. The procedure involves analysis of a patient specimen in a clinical molecular laboratory to determine the presence or absence of specific prothrombin gene variants associated with altered coagulation risk.
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Service type: Molecular diagnostic genetic testing
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Typical site of service: Clinical molecular laboratory or hospital laboratory with molecular diagnostics capability
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Clinical & Coding Specifications
Clinical Context
A 32-year-old woman with a strong family history of venous thromboembolism presents to a hematology clinic for evaluation after two unprovoked deep vein thromboses. Her provider documents a need to evaluate for inherited thrombophilia, including the prothrombin G20210A variant. A phlebotomy order is placed and a blood specimen is sent to the molecular diagnostics laboratory. The lab analyst performs 81240 testing using PCR-based or sequencing methods to detect the common prothrombin (F2) gene change. Results are reported to the ordering hematologist, included in the electronic medical record, and used to guide anticoagulation counseling and family risk assessment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation component if split billing applies. |
90 | Reference (outside) laboratory | Use when the test is performed by an outside reference laboratory and billing needs to reflect that. |