Summary & Overview
CPT 81247: G6PD Gene Variant Analysis
CPT code 81247 designates molecular laboratory testing for common variants of the glucose–6–phosphate dehydrogenase (G6PD) gene, including variants such as A and A–. This genetic test is clinically important for identifying G6PD deficiency risk, which can affect medication selection, neonatal screening, and management of hemolytic anemia. Nationally, accurate billing and coding for G6PD molecular analysis supports appropriate reimbursement and tracking of genetic diagnostic services.
Payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The summary addresses payer coverage considerations, coding and billing context, and typical sites where this service is performed.
Readers will learn what CPT code 81247 represents, the clinical context for ordering the test, common sites of service, and what to expect in payer coverage landscapes. The publication also outlines benchmark themes and policy considerations relevant to molecular diagnostic genetic testing for G6PD variants. Data not available in the input is noted where payer-specific rules, associated taxonomies, and ICD-10 diagnosis pairings would be required for operational billing guidance.
Billing Code Overview
CPT code 81247 reports laboratory analysis of common variants of the glucose–6–phosphate dehydrogenase (G6PD) gene, such as the A and A– variants. The service represents a molecular diagnostic genetic test performed by a clinical laboratory to identify common G6PD gene variants that affect enzyme function.
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Service type: Molecular diagnostic testing / genetic variant analysis
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Typical site of service: Clinical laboratory or independent diagnostic testing facility (IDTF) performing molecular/genetic testing
Clinical & Coding Specifications
Clinical Context
A typical scenario involves a patient, often a male of African, Mediterranean, Middle Eastern, or Southeast Asian descent, with a history of hemolytic anemia, neonatal jaundice, or suspected drug- or infection-triggered hemolysis. A clinician orders G6PD genetic testing when enzymatic testing is inconclusive, when a molecular diagnosis is needed for family counseling, or to identify common variants such as A and A− that explain reduced enzyme activity.
Workflow: the patient presents to an outpatient hematology clinic or newborn screening follow-up visit. A phlebotomy draw is performed at an ambulatory laboratory or hospital outpatient lab. The specimen is sent to a molecular diagnostics laboratory where a molecular technologist or lab analyst performs the 81247 assay to detect common G6PD gene variants. Results are returned to the ordering clinician, who documents the indication, test result, and any implications for medication avoidance and family screening. Typical sites of service include an outpatient laboratory, hospital outpatient department, or specialized molecular diagnostics lab.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component |