Find policies, billing codes, payers, states, and providers
CPT 81403: Tier 2 Level 4 Molecular Pathology, Laboratory Technical Component
CPT code 81403 represents the technical laboratory component of a Tier 2, Level 4 molecular pathology procedure. It designates the hands-on laboratory work performed by a lab analyst to complete a specific genetic analysis. As molecular diagnostics expand across clinical care, technical-component codes such as 81403 are central to billing for laboratory services that generate data used in diagnosis, prognosis, and treatment planning.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical role, typical sites of service, and how it relates to other molecular pathology levels. The publication provides benchmarking context for utilization and coverage patterns, summarizes common billing modifiers and claim considerations, and outlines associated clinical scenarios and ICD-10 diagnoses commonly paired with this service.
This summary is intended for a national audience of laboratory administrators, coding and compliance staff, and policy analysts seeking a clear reference on how CPT code 81403 is used in molecular pathology billing and where it fits among related procedure codes.
Customize your policy alerts
Sign up for cpt 81403 policy alerts
Get alerted when payer policies referencing 81403 are released or updated.
Monitor payer policy activity
Billing Code Overview
CPT code 81403 describes a technical laboratory procedure for performing a specific Tier 2, Level 4 molecular pathology test. The lab analyst carries out the laboratory portion of a defined genetic analysis to generate raw or processed molecular data required for test interpretation.
Service type: Molecular pathology — technical component (laboratory test execution)
Typical site of service: Clinical laboratory or hospital laboratory setting
National Reimbursement Benchmarks
Commercial rates for CPT 81403 show meaningful variation around the BUCA average commercial rate of $246.00. Blue Cross Blue Shield exhibits the highest dispersion (P75 $337.60 minus P25 $226.80 = $110.80), indicating broader negotiated outcomes, while Aetna’s interquartile spread is tighter (P75 $148.20 minus P25 $60.00 = $88.20) relative to BCBS and Cigna. UnitedHealth Group has the narrowest IQR (P75 $185.20 minus P25 $77.80 = $107.40) — slightly wider than Aetna on absolute dollars but smaller compared with BCBS’s large spread when considering its high upper percentiles.
Looking at central tendency, Cigna’s median of $172.10 and UnitedHealth Group’s median of $111.10 flank the BUCA average, suggesting BUCA sits above some major payers’ midpoints. Blue Cross Blue Shield’s high dispersion plus a median of $265.40 points to more upward variability in contracted rates, while Aetna’s statistics reflect a lower median of $100.00 with a comparatively modest IQR.