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CPT 81402: Molecular Pathology Technical Laboratory Test
CPT code 81402 designates a Tier 2, Level 3 molecular pathology procedure covering the technical laboratory work required to complete specific genetic analyses. As a technical-only code, it captures the laboratory processes, instrumentation, and analytic steps performed by a lab analyst rather than the professional interpretation component. Nationally, molecular pathology codes like 81402 are central to billing for increasingly common genomic tests used in diagnostic evaluation, disease screening, and targeted therapy selection.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for 81402, comparative payer coverage presence, and how this code relates to adjacent molecular pathology levels (for example, Level 2 and Level 4 procedures). The publication summarizes the service type, typical laboratory site of service, common clinical indications tied to relevant ICD-10 diagnoses, and payor considerations affecting billing workflows.
This summary provides operational clarity for coding teams, revenue cycle staff, and laboratory managers seeking to align molecular testing services with payer expectations and internal billing practices. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 81402 describes a Tier 2, Level 3 molecular pathology procedure in which a lab analyst performs the technical laboratory testing required to complete a specified genetic analysis. The code applies to defined molecular assays that require technical processing, instrumentation, and analytic steps performed by laboratory personnel rather than interpretive services.
Service type: Technical molecular laboratory testing performed by a laboratory analyst for a specified molecular pathology procedure.
Typical site of service: Clinical or hospital laboratory or other certified diagnostic laboratory environment where molecular genetic testing is performed.
National Reimbursement Benchmarks
National commercial reimbursement centers on BUCA’s average commercial rate of $222.50 for CPT 81402, with individual payers showing notable spread around that midpoint. Blue Cross Blue Shield displays the widest middle spread (P75–P25 = $125.10), reflecting greater variability in negotiated commercial rates, while Aetna’s middle 50% is much tighter (P75–P25 = $11.20), indicating more clustered pricing. Cigna and UnitedHealth Group show moderate dispersion (Cigna P75–P25 = $121.75; UnitedHealth Group P75–P25 = $87.70), and BUCA’s IQR (P75–P25 = $106.30) sits between those extremes.
Mean rates also vary: Blue Cross Blue Shield and BUCA have higher averages ($290.80 and $222.50 respectively), while Aetna and UnitedHealth Group have lower means ($87.20 and $119.90 respectively), with Cigna in the middle at $187.10. This mix of mean levels and interquartile spreads highlights that some payers price more consistently at lower levels and others show both higher averages and greater variability in commercial reimbursement for this code.