Summary & Overview
CPT 81283: IFNL3 (rs12979860) Genotyping
CPT code 81283 represents a molecular diagnostic test for the IFNL3 gene variant rs12979860. This genetic assay identifies a single-nucleotide variation that has clinical relevance in infectious disease management and pharmacogenomics. As a lab-only, specimen-based molecular test, it is performed by trained laboratory personnel using specialized equipment and reported as a discrete result.
Key national payers typically included in coverage discussions are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage and payment policies vary across these organizations and can affect patient access and lab billing practices nationwide.
Readers will find a concise overview of the code’s clinical context, the typical laboratory service setting, and what to expect in payer coverage discussions. The publication summarizes benchmark payment considerations, common billing modifiers associated with lab services, and the clinical implications of rs12979860 genotyping for clinicians and laboratory managers. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 81283 describes a molecular laboratory test that detects the presence of genetic variation in the interferon, lambda 3 (IFNL3) gene, specifically the rs12979860 single nucleotide variant. The procedure involves laboratory analysis of a patient specimen to determine the genotype at this locus.
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Service type: Molecular diagnostic / genetic testing
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Typical site of service: Clinical laboratory or hospital laboratory setting
Clinical & Coding Specifications
Clinical Context
A 48-year-old patient with chronic hepatitis C infection is referred to a clinical laboratory for host genetic testing to inform antiviral therapy selection. The provider collects a peripheral blood specimen during an outpatient hepatology clinic visit; the specimen is sent to a molecular diagnostics laboratory. The laboratory performs a targeted genotyping assay to detect the rs12979860 single nucleotide polymorphism in the interferon lambda 3 gene (IFNL3), reported as CC, CT, or TT. Results are returned to the ordering hepatologist and incorporated into the clinical record to assist with historical treatment response expectations and discussion of therapeutic options. Typical site of service is an outpatient clinic or independent clinical molecular laboratory; the service is a laboratory technical/genetic test performed by trained medical technologists and molecular pathologists.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation component if separated from the technical component. |
TC | Technical component | Use when billing only the laboratory technical component (instrumentation, reagents, processing). |