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CPT 81401: Molecular Pathology Technical Laboratory Analysis
CPT code 81401 represents a Tier 2, Level 2 molecular pathology procedure in which a laboratory analyst completes the technical laboratory testing portion of a specified genetic analysis. This code captures the technical component of molecular diagnostic assays used to detect genetic variants relevant to oncology, hereditary disease assessment, and other genomic indications. Nationally, accurate coding of molecular pathology services affects laboratory billing, payer coverage determinations, and downstream clinical reporting.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. The analysis covers common billing practices for the technical portion of molecular tests, how payers typically approach coverage of Tier 2 molecular pathology codes, and the clinical contexts in which 81401 is most frequently used.
Readers will find a concise overview of the clinical role of the code, payer coverage landscape, commonly paired service descriptors, and relevant coding relationships (including related higher-level molecular pathology codes such as 81403). The content outlines operational considerations for laboratories and billing teams, clarifies typical sites of service, and summarizes ICD-10 diagnosis contexts where this molecular pathology technical component is often reported. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 81401 describes a Tier 2, Level 2 molecular pathology service in which the laboratory analyst performs the technical component of a specified genetic test. The service type is technical laboratory testing for molecular genetic analysis, and the typical site of service is a clinical laboratory or pathology laboratory where molecular diagnostic testing is performed.
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.