Summary & Overview
CPT 81273: KIT Gene D816 Variant Molecular Test
CPT code 81273 covers laboratory testing for the D816 variant or variants of the KIT gene, a molecular diagnostic assay used to identify clinically relevant mutations. Nationally, such targeted genetic tests inform diagnosis, prognosis, and therapeutic decisions in oncology and related specialties, and they are increasingly important as precision medicine expands.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of coverage patterns across major payers, typical sites of service, and clinical context for KIT D816 variant testing. The publication situates CPT code 81273 within laboratory service lines and summarizes how this specific molecular assay is billed and categorized.
The report provides benchmarks for utilization where available, highlights policy and coverage considerations relevant to molecular oncology testing, and outlines clinical implications of detecting D816 KIT variants. Data not available in the input are noted where details such as associated taxonomies, ICD-10 diagnoses, and payer-specific coding edits are not provided.
Billing Code Overview
CPT code 81273 describes a laboratory technical procedure to evaluate the D816 variant or variants of the v–kit Hardy–Zuckerman 4 feline sarcoma viral oncogene homolog (KIT) gene. The service involves molecular testing performed by a lab analyst to detect specific KIT gene variants associated with clinical conditions.
Service Type: Molecular diagnostic laboratory test
Typical Site of Service: Clinical laboratory or hospital laboratory (laboratory-based service)
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with metastatic gastrointestinal stromal tumor (GIST) undergoes molecular testing to identify activating mutations in the KIT proto-oncogene, specifically the D816 variant. Tumor tissue obtained at biopsy or surgical resection is sent to a clinical molecular laboratory. The laboratory analyst performs the technical sequencing assay to detect D816 and other relevant KIT variants using targeted DNA sequencing or allele-specific PCR. Results guide oncologist selection of targeted therapies (for example, tyrosine kinase inhibitors) and inform prognosis. Typical workflow: specimen accessioning → DNA extraction → library preparation or PCR setup → sequencing or targeted assay run → bioinformatic analysis → technical result reporting to the sign-out molecular pathologist. Typical site of service is a clinical molecular diagnostics laboratory within a hospital or independent reference laboratory.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the professional interpretation component, if applicable and separable |
TC | Technical component |