Summary & Overview
CPT 81307: PALB2 Gene Full Sequencing
Headline: CPT code 81307: Comprehensive PALB2 Gene Sequencing Gains Clinical Importance
Lead: CPT code 81307 denotes complete gene sequencing of PALB2, a molecular diagnostic laboratory test that identifies sequence variants across the PALB2 gene from a specimen such as blood. The code supports clinical decision-making for inherited cancer risk assessment and informs downstream management and family counseling.
What this code represents and national significance: CPT code 81307 represents full sequencing of the PALB2 gene (partner and localizer of BRCA2). Nationally, comprehensive PALB2 testing is an important component of hereditary breast and ovarian cancer assessment, expanding the genetic evaluation beyond BRCA1/2 and influencing surveillance and risk-reduction strategies.
Key payers covered: Analysis typically considers major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: This publication summarizes the clinical context and use cases for CPT code 81307, typical sites of service (clinical and hospital laboratories), and operational considerations for laboratory reporting. It highlights benchmarking and coverage patterns where available, notes common billing modifiers provided in the input, and identifies gaps where data was not provided. The piece is intended to inform billing, coding, and policy stakeholders about the role of PALB2 full gene sequencing in genetic diagnostics and payer engagement at a national level.
Billing Code Overview
CPT code 81307 describes a laboratory procedure in which the technical component analyzes the entire gene sequence for the partner and localizer of BRCA2 (PALB2) from a biologic specimen such as blood. This service is a molecular genetics sequencing test that targets the PALB2 gene to detect sequence variants across the gene.
Service Type: Molecular genetic sequencing / diagnostic laboratory test
Typical Site of Service: Clinical laboratory or hospital laboratory (specimen collection such as blood; testing performed in a laboratory setting)
Clinical & Coding Specifications
Clinical Context
A 42-year-old woman with a family history of early-onset breast cancer is referred to a genetic counselor after her sister tested positive for a pathogenic PALB2 variant. The clinician orders comprehensive sequencing of the PALB2 gene to identify inherited pathogenic or likely pathogenic variants that could alter cancer risk management. A blood sample is collected in the outpatient phlebotomy clinic and sent to a molecular diagnostics laboratory. The lab analyst performs the technical sequencing and bioinformatic analysis of the entire PALB2 gene to detect single-nucleotide variants, small insertions and deletions, and other sequence-level abnormalities. Report generation includes variant classification according to ACMG guidelines and a technical report transmitted to the ordering provider. Typical sites of service include an outpatient clinic, ambulatory surgery center laboratory draw station, or a reference molecular diagnostics laboratory receiving couriered specimens.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation of results separate from the lab technical component. |
TC | Technical component |