Summary & Overview
CPT 81400: Molecular Pathology Procedure, Level I
CPT code 81400 is a foundational billing code for molecular pathology procedures, specifically Level I tests that identify single germline variants such as SNPs. This code is widely used in clinical laboratories and hospital outpatient settings to support genetic screening and diagnostic services. The procedure is integral to modern precision medicine, enabling clinicians to detect genetic anomalies that may influence patient management and treatment decisions.
Major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare provide coverage for services billed under CPT code 81400. Understanding payer policies and coverage criteria is crucial for laboratories and providers to ensure appropriate billing and reimbursement. This publication offers a comprehensive overview of payer coverage, clinical indications, and relevant benchmarks for CPT code 81400.
Readers will gain insights into the clinical context of molecular pathology Level I procedures, recent policy updates, and the role of this code in genetic testing workflows. The summary also highlights associated ICD-10 diagnoses, common modifiers, and related CPT codes, equipping stakeholders with the information needed to navigate the evolving landscape of molecular diagnostics billing and compliance.
CPT Code Overview
CPT code 81400 represents a Level I molecular pathology procedure. This code is used for the identification of a single germline variant, such as a single nucleotide polymorphism (SNP), utilizing techniques like restriction enzyme digestion or melt curve analysis. The service type is molecular pathology and is typically performed in a laboratory setting (POS 81) or in a hospital outpatient department (POS 22). These procedures are essential for genetic screening and diagnostic purposes, providing critical information for patient care.
Clinical & Coding Specifications
Clinical Context
A patient presents for genetic screening or evaluation due to a family history of chromosomal abnormalities, unexplained metabolic disorders, or abnormal laboratory findings. The ordering provider, such as a family medicine physician, internist, or obstetrician/gynecologist, requests a molecular pathology test to identify a single germline variant (such as a single nucleotide polymorphism [SNP]). The laboratory performs the procedure using techniques like restriction enzyme digestion or melt curve analysis. Results are interpreted by a pathologist and reported back to the ordering provider for further clinical management. This workflow typically occurs in a laboratory setting (POS 81) or hospital outpatient department (POS 22).
Coding Specifications
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Modifier
26: Used to indicate the professional component of the service, typically when the provider is responsible for interpreting the results but not performing the technical aspects of the test. -
Modifier
TC: Used to indicate the technical component, which covers the performance of the test in the laboratory, including equipment and staff.
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