Summary & Overview
CPT 81241: Factor V Leiden (F5) Genetic Variant Detection
CPT code 81241 represents a molecular diagnostic test that detects the Factor V Leiden (F5) variant, a common inherited change associated with increased thrombotic risk. This single-gene variant assay is clinically important for evaluating patients with unexplained venous thromboembolism, recurrent pregnancy loss, or for family risk assessment, and it affects diagnostic workflows in hematology and coagulation management nationwide. Payers commonly encountered in coverage and billing analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of the clinical purpose of 81241, how it fits into laboratory service lines, and typical sites where the service is delivered. The publication provides benchmarks and comparisons for payer coverage and reimbursement practices, contextual discussion of clinical indications for testing, and any recent policy updates relevant to molecular diagnostic billing. The content is intended for billing analysts, laboratory managers, and policy teams seeking a national perspective on how Factor V Leiden testing is coded and reimbursed. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 81241 describes a laboratory genetic test that detects the common Factor V Leiden (Leiden variant) in the gene for coagulation factor V (F5). This test identifies a specific genetic change that increases risk of abnormal blood clotting.
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Service type: Molecular diagnostic / genetic variant detection
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Typical site of service: Clinical laboratory or hospital laboratory performing specialized molecular testing
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Clinical & Coding Specifications
Clinical Context
A 34-year-old woman with a history of unprovoked deep vein thrombosis at age 29 is referred for thrombophilia testing to evaluate inherited risk factors for recurrent venous thromboembolism prior to discontinuation of anticoagulation. The treating hematologist orders a laboratory test for the Factor V Leiden mutation. The specimen (whole blood or EDTA) is collected at an outpatient phlebotomy clinic or hospital lab, labeled, and sent to a molecular diagnostics laboratory. In the lab, a molecular analyst performs DNA extraction and a targeted assay (PCR-based or sequencing) to detect the common G1691A (Leiden) variant in the F5 gene. Results are reported to the ordering provider and stored in the electronic health record; positive results inform clinical discussions about long-term anticoagulation, prophylaxis in high-risk situations, and family testing. Typical sites of service include outpatient clinic laboratories, hospital laboratories, and independent molecular diagnostic laboratories. Typical patient scenarios include evaluation after an unexplained venous thromboembolism, recurrent pregnancy loss workup, young patients with thrombosis, or family history of Factor V Leiden.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation component separate from the technical laboratory processing when applicable. |