Summary & Overview
CPT 81350: UGT1A1 Genetic Variant Detection, Laboratory Technical Service
CPT code 81350 represents a laboratory molecular diagnostic test for common variants in the UGT1A1 gene. This code captures the technical component of testing performed by a lab analyst to detect genetic changes that influence bilirubin metabolism and drug conjugation, making it relevant for pharmacogenomics and hepatic disorder evaluations. Nationally, UGT1A1 testing is important for identifying patients at risk for irinotecan toxicity and hereditary unconjugated hyperbilirubinemia, which informs clinical decision-making and medication safety.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical context, typical sites of service, and common billing modifiers. The publication summarizes payer coverage themes, coding and billing considerations, and benchmarks where available. It also outlines the clinical scenarios that commonly prompt testing and the implications for pharmacogenomic management.
The report is intended for billing professionals, laboratory managers, and clinicians seeking a clear reference on CPT code 81350, including operational implications for laboratory workflows and payer interactions. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 81350 describes a laboratory molecular test in which a lab analyst performs the technical component to detect common genetic variations in the UGT1A1 gene (UDP glucuronosyltransferase 1 family, polypeptide A1). The service is a genetic test targeting variants that can affect drug metabolism and bilirubin processing.
Service type: Clinical molecular diagnostic testing (technical component)
Typical site of service: Clinical laboratory or reference diagnostic laboratory
Clinical & Coding Specifications
Clinical Context
A 28-year-old adult of Middle Eastern descent is referred by a hematologist for genetic testing after persistent unconjugated hyperbilirubinemia is noted on serial liver function testing and pharmacogenetic consideration is required before initiating irinotecan chemotherapy. The outpatient clinical workflow begins with the ordering provider (hematology/oncology or gastroenterology) placing an order for UGT1A1 genotyping (CPT 81350). A specimen (typically whole blood or buccal swab) is collected in the clinic or phlebotomy lab, labeled with the patient identifiers, and sent to a molecular diagnostics laboratory. The lab analyst performs the technical assay to detect common variants in the UGT1A1 gene (e.g., UGT1A1 *28 allele), documents analytic results, and forwards a report to the ordering provider. The ordering provider integrates genotype results into the clinical record to explain Gilbert syndrome, predict risk for irinotecan toxicity, or guide medication dosing. Typical sites of service include outpatient clinics, hospital outpatient laboratories, and commercial reference molecular laboratories. The typical patient scenario includes pre-chemotherapy pharmacogenetic assessment, evaluation of unexplained mild unconjugated hyperbilirubinemia, or family history–driven carrier testing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component |