CPT 81308 PALB2 Targeted Test Reimbursement | OpenPayer

Summary & Overview

CPT 81308: Targeted PALB2 (partner and localizer of BRCA2) Variant Test

Headline: CPT code 81308: Targeted PALB2 (partner and localizer of BRCA2) testing for known familial variants

Lead: CPT code 81308 denotes a targeted molecular diagnostic test for the PALB2 gene used to detect a known familial variant from a patient specimen such as blood. This focused test supports clinical decision-making for patients with a family history of PALB2-related hereditary cancer risk.

What this code represents and why it matters: CPT code 81308 covers a single-gene, known-variant analysis of PALB2, enabling confirmation of familial pathogenic or likely pathogenic variants. Targeted testing can be faster and less expensive than full-gene sequencing and is clinically important for confirmation of inherited cancer risk in family members.

Key payers covered: This publication addresses national payer considerations including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

What readers will learn: The report provides benchmarks and payer coverage context for CPT code 81308, summarizes clinical use cases for targeted familial variant testing, and outlines typical laboratory and site-of-service settings. It also highlights common billing modifiers and coding considerations. Data not available in the input for payer-specific reimbursement rates, ICD-10 linkages, associated taxonomies, and related codes are noted as unavailable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 81308genetic testingPALB2molecular pathologytargeted testinglaboratoryhereditary cancerdiagnostic testing

Billing Code Overview

CPT code 81308 describes a targeted molecular laboratory test performed by a lab analyst to analyze the partner and localizer of BRCA2 (PALB2) gene for a known familial variant on a patient specimen such as blood. The service type is targeted genetic testing / molecular pathology. The typical site of service is a clinical diagnostic laboratory or reference molecular laboratory where blood or other patient specimens are processed and analyzed for a specific known familial PALB2 variant.

Clinical & Coding Specifications

Clinical Context

A 42-year-old woman with a strong family history of breast and ovarian cancer presents to a genetics clinic for targeted familial variant testing. A relative was previously identified with a pathogenic PALB2 variant. The clinician orders a laboratory test to detect that known familial PALB2 variant using the patient’s peripheral blood specimen. The workflow: the clinic obtains informed consent, collects a blood sample (or saliva if validated), completes the lab requisition specifying the known familial variant, and ships the specimen to a molecular diagnostics laboratory. In the laboratory, a molecular technologist extracts DNA and performs targeted variant analysis (e.g., PCR-based assay or Sanger sequencing) focusing on the specified PALB2 change. Results are reviewed by a laboratory director, documented in the report, and communicated back to the ordering clinician for patient counseling and management planning.

Coding Specifications

Modifier	Description	When to Use
`00`	Standard — no modifier	Use when no special circumstances apply and full service was provided.
`11`	Active/primary surgeon or provider	Use when the billing provider is the primary laboratory performing and directing the test.

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CPT-81291-MTHFR-GENE-COMMON-VARIANT-DETECTION

CPT 81291: MTHFR Gene Common Variant Detection

CPT-81271-HUNTINGTIN-GENE-HTT-EXPANDED-ALLELE-DETECTION

CPT 81271: Huntingtin (HTT) Gene Expanded Allele Detection

CPT-81224-CFTR-INTRON-8-POLY-T-MUTATION-TEST

CPT 81224: CFTR Intron 8 Poly-T Mutation Analysis

CPT-81310-NPM1-GENE-MUTATION-DETECTION-MOLECULAR-TEST

CPT 81310: NPM1 Gene Mutation Detection, Molecular Diagnostic Test

CPT-81295-MSH2-GENE-SEQUENCING-FULL-GENE-ANALYSIS

CPT 81295: Full-Gene Sequencing of MSH2 (MutS Homolog 2)

CPT-81247-G6PD-GENE-VARIANT-ANALYSIS

CPT 81247: G6PD Gene Variant Analysis

CPT-81241-FACTOR-V-LEIDEN-GENETIC-VARIANT-TEST

CPT 81241: Factor V Leiden (F5) Genetic Variant Detection

CPT-81191-NTRK1-TRANSLOCATION-TESTING-FFPE-TISSUE

CPT 81191: NTRK1 Translocation Testing on FFPE Tumor Tissue

CPT-81279-JAK2-GENE-SEQUENCING-EXONS-12-13

CPT 81279: JAK2 Gene Sequencing for Exons 12 and 13

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Taxonomy Code	Specialty	Notes
170100000X	Medical Genetics	Clinical and laboratory medical geneticists directing molecular testing and interpretation.
2085P0200X	Pathology — Molecular Genetic Pathology	Pathologists with subspecialty in molecular diagnostics overseeing assay validation and reporting.
208000000X	Pathology	Laboratory directors and clinical pathologists supervising molecular laboratories.
363L00000X	Laboratory — Molecular Diagnostics	Clinical laboratory professionals and laboratory directors performing high-complexity molecular testing.
207Q00000X	Oncology	Medical oncologists ordering targeted familial variant testing for risk assessment and management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z15.01`	Genetic susceptibility to malignant neoplasm of breast	Indicates known familial susceptibility where targeted PALB2 familial variant testing is clinically relevant.
`Z15.02`	Genetic susceptibility to malignant neoplasm of ovary	Relevant when family history includes ovarian cancer prompting PALB2 familial testing.
`Z80.3`	Family history of malignant neoplasm of breast	Family history that justifies targeted familial variant testing for PALB2.
`Z80.41`	Family history of malignant neoplasm of ovarian cancer	Family history supporting PALB2 analysis for inherited risk.
`Z84.81`	Family history of genetic carrier of other single gene defect	Used when a familial PALB2 pathogenic variant carrier is known and testing for that variant is ordered.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`81162`	BRCA1 and BRCA2 analysis for a known familial variant	Closely related targeted familial variant test when the known variant is in BRCA genes rather than PALB2.
`81211`	BRCA1 gene full sequence analysis by sequencing methods	Used when full sequencing of BRCA1 is performed instead of a targeted familial variant assay.
`81479`	Unlisted molecular pathology procedure	Used when no specific CPT exists for a particular molecular assay; rarely used if a unique assay is performed.
`0017U`	Molecular pathology procedure (example lab-specific CPT II/Category III style proprietary code)	Used by some laboratories for proprietary or new molecular assays; may accompany targeted testing workflows.
`81161`	BRCA1 and BRCA2 targeted familial variant analysis	Another targeted familial variant code for BRCA genes; analogous workflow to PALB2 targeted testing.

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