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    v1.0.30
    OpenPayerBilling CodesTier 2 Molecular Pathology ProceduresCPT cpt-81401-molecular-pathology-technical-lab-analysis
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    CPT 81401: Tier 2, Level 2 Molecular Pathology Technical Test

    Commercial payers pay $127 on average nationally for this procedure.

    CPT code 81401 describes a Tier 2, Level 2 molecular pathology technical service in which a lab analyst performs the technical laboratory testing required to complete a specified genetic analysis; the service is classified as molecular diagnostic laboratory testing and is typically provided in a clinical laboratory or hospital laboratory setting.

    For related coverage guidance, see recent payer policy updates: Oral Cancer Screening and Testing, RTM Testing for Alpha-1 Antitrypsin Deficiency, Cytochrome P450 Genotype-Guided Treatment Strategy Corporate Medical Policy.

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    National Reimbursement Benchmarks

    For CPT 81401, the BUCA average commercial benchmark is $126.70, providing a mid-market reference point among major national payers. Blue Cross Blue Shield (BCBS) and Cigna show higher central tendencies with medians of $128.10 and $136.70 respectively, while UnitedHealth Group’s median sits lower at $82.20 and Aetna’s median at $65.00, indicating dispersion in contracted commercial pricing around the BUCA average.

    Examining interquartile dispersion (P75 minus P25) highlights concentration differences: Aetna has the tightest IQR at $70.50 (P75 $109.50 minus P25 $39.00), UnitedHealth Group follows with an IQR of $81.50, and BUCA’s IQR is $78.80. Cigna displays the widest IQR at $129.40, with Blue Cross Blue Shield also wide at $63.00. These comparisons show Cigna and BCBS exhibiting broader mid-distribution spread, while Aetna and UnitedHealth Group are relatively tighter around their medians.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 52-year-old woman with a prior history of breast cancer (Z85.3) presents for molecular tumor profiling after a suspicious mass is identified on imaging. A tissue sample is submitted to a clinical molecular laboratory where a laboratory analyst performs a technical molecular pathology assay represented by 81401 to evaluate specific genetic alterations in the specimen. The analytic workflow includes specimen accessioning, nucleic acid extraction, quality control, targeted molecular analysis (e.g., single-gene or small-panel testing consistent with a Tier 2, Level 2 molecular pathology procedure), instrument run, and generation of raw data files. The laboratory scientist documents technical results and transfers the technical component to the laboratory information system; the professional component (interpretation and report sign-out) is performed by a molecular pathologist and billed separately when applicable.

    • Typical site of service: Clinical molecular laboratory or hospital-based pathology laboratory.

    • Typical patient scenario: Patients with known or suspected malignancy (e.g., C80.1, D47.9) or individuals undergoing genetic screening or with relevant family history (e.g., Z13.79, Z84.81) where targeted molecular testing informs prognosis, therapeutic options, or genetic risk assessment.

    • Workflow roles: Ordering clinician (oncologist, surgeon, or geneticist) → specimen collection (surgical pathology/biopsy) → clinical molecular laboratory (technical assay by analyst billed as ) → molecular pathologist interpretation (professional component) → integrated report to ordering clinician.

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    90Modifier ‑90 (Reference/Outside Laboratory) indicates that a laboratory test was performed by an entity other than the treating or reporting provider. The American Medical Association defines…- Use CPT modifier -90 when a laboratory test is performed by an outside/reference laboratory (an entity other than the treating or reporting physician or qualified professional) and the claim needs…
    91Modifier 91 — “Repeat Clinical Diagnostic Laboratory Test” — is appended when the exact same CPT laboratory test is performed more than once for the same patient on the same day because serial,…- Use modifier 91 when the exact same CPT laboratory test is performed more than once on the same patient on the same date because serial or repeated testing is medically necessary to monitor…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    291U00000X
    207ZP0102X
    207ZP0105X
    302F00000X
    207QA0000X
    227900000X
    333600000X
    2278C0205X

    Related ICD-10-CM Codes

    33 rows

    ICD-10-CM CodeDescription
    C34.90Malignant neoplasm of unspecified part of unspecified bronchus or lung
    C50.912Malignant neoplasm of unspecified site of left female breast
    C61Malignant neoplasm of prostate
    C80.1Malignant (primary) neoplasm, unspecified
    D47.9Neoplasm of uncertain behavior of lymphoid, hematopoietic and related tissue, unspecified
    D50.9Iron deficiency anemia, unspecified
    D64.9Anemia, unspecified
    E03.9Hypothyroidism, unspecified
    E11.9Type 2 diabetes mellitus without complications
    E66.9Obesity, unspecified

    Showing 1–10 of 33

    Related Payer Policy Updates

    Specialty: Genetic & Molecular Testing1 / 2

    10 rows

    PolicyPayerEffective Date
    Oral Cancer Screening and TestingOscar Health2027-01-01
    RTM Testing for Alpha-1 Antitrypsin DeficiencyOscar Health2027-01-01
    Cytochrome P450 Genotype-Guided Treatment Strategy Corporate Medical Policybcbsvermont2027-01-01
    Carrier Testing Panels for Genetic Diseases (for Kentucky Only)UnitedHealthcare2026-10-01
    Genetic Testing for Neurological Disorders (for Kansas Only)UnitedHealthcare2026-10-01
    Genetic and Molecular TestingProvidence Health Plan2026-10-01
    Cell-Free Fetal DNA Testing (for Idaho Only)UnitedHealthcare2026-10-01
    Next Generation Sequencing for Minimal Residual Disease DetectionProvidence Health Plan2026-10-01
    Pharmacogenetic Panel Testing (for Kansas Only)UnitedHealthcare2026-10-01
    Non-Covered Genetic Panel TestsProvidence Health Plan2026-10-01

    Related Codes

    CPT-81400-MOLECULAR-PATHOLOGY-TECHNICAL-LAB-PROCEDURE

    CPT 81400: Molecular Pathology Tier 2, Level 1 Technical Test

    CPT-81402-MOLECULAR-PATHOLOGY-LEVEL-3-TECHNICAL-TEST

    CPT 81402: Molecular Pathology Tier 2 Level 3 Technical Test

    CPT-81403-TIER-2-LEVEL-4-MOLECULAR-PATHOLOGY-TECHNICAL

    CPT 81403: Molecular Pathology Technical Component, Tier 2 Level 4

    CPT-81404-TIER-2-MOLECULAR-PATHOLOGY-TECHNICAL-COMPONENT

    CPT 81404: Molecular Pathology Technical Laboratory Procedure

    CPT-81405-MOLECULAR-PATHOLOGY-TECHNICAL-LAB-TESTING

    CPT 81405: Tier 2 Level 6 Molecular Pathology Lab Test

    CPT-81406-MOLECULAR-PATHOLOGY-TECHNICAL-LAB-ANALYSIS

    CPT 81406: Molecular Pathology Tier 2, Level 7 Technical Component

    CPT-81407-TIER-2-LEVEL-8-MOLECULAR-PATHOLOGY-TECHNICAL-TEST

    CPT 81407: Technical Molecular Pathology Lab Test

    CPT-81408-MOLECULAR-PATHOLOGY-TECHNICAL-TIER-2-LEVEL-9

    CPT 81408: Tier 2 Molecular Pathology Technical Laboratory Analysis

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    81401

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    81403Molecular pathology procedure, Level 4 (eg, analysis of single exon by DNA sequence analysis, analysis of >10 amplicons using multiplex PCR in 2 or more independent reactions, mutation scanning or duplication/deletion variants of 2‑5 exons)A higher complexity molecular pathology assay that may be performed instead of or in addition to the 81401 Tier 2, Level 2 technical analysis when more extensive analytic coverage is required.