Summary & Overview
CPT 81242: FANCC Gene Targeted Genetic Test
CPT code 81242 represents a laboratory technical procedure to detect common sequence changes in the FANCC gene, linked to Fanconi anemia group C. Nationally, accurate coding for targeted genetic tests like this is important for clinical care, laboratory workflow, and payer coverage determinations for hereditary bone marrow failure syndromes. The code applies to technical laboratory work performed in a clinical molecular diagnostics setting.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code's clinical purpose, typical site-of-service context, and payer coverage considerations. The publication summarizes common modifiers associated with technical and professional components, clarifies expected service type, and outlines where additional documentation or test-specific clinical indications are typically required by payers.
The content provides benchmarks and policy context relevant to molecular diagnostic billing, highlights clinical scenarios in which testing for FANCC variants is relevant, and notes where input was not available. Data not available in the input includes associated taxonomies, specific ICD-10 indications, related codes, and service line details.
Billing Code Overview
CPT code 81242 describes a laboratory technical test to detect common changes in the FANCC gene (Fanconi anemia, complementation group C). The service represents targeted genetic testing performed by a laboratory analyst to identify pathogenic variants associated with Fanconi anemia affecting the FANCC gene.
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Service type: Genetic testing / Molecular diagnostic assay
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Typical site of service: Clinical laboratory or molecular diagnostics laboratory
Clinical & Coding Specifications
Clinical Context
A 6-year-old child with progressive bone marrow failure and multiple congenital anomalies (short stature, abnormal skin pigmentation, and absent radii) is referred for genetic testing to evaluate for Fanconi anemia. A pediatric hematologist orders targeted genetic testing for common mutations in the FANCC gene to confirm diagnosis, inform family counseling, and guide transplant and surveillance planning. The clinical workflow: sample collection (peripheral blood or buccal swab) at an outpatient pediatric clinic or specialized genetics laboratory; sample accessioning and DNA extraction in the molecular genetics laboratory; performance of the technical assay (targeted mutation analysis or sequencing) by a lab analyst; generation of raw data and technical report; review and interpretation by a board-certified molecular geneticist; and issuance of a final report to the ordering hematologist. Typical site of service: outpatient ambulatory clinic for specimen collection with testing performed in a clinical molecular diagnostics laboratory.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing for the interpreting geneticist's professional interpretation separate from the laboratory technical component. |
TC |