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

Commercial payers pay $246 on average nationally for this procedure.

CPT code 81403 describes a Tier 2, Level 4 molecular pathology technical service in which a laboratory analyst performs the technical laboratory testing required to complete a specified genetic analysis; service type: molecular pathology technical component; typical site of service: clinical laboratory or hospital laboratory performing molecular diagnostic testing.

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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.

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

Commercial payers pay $246 on average nationally for this procedure.

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

Receive email alerts as soon as relevant payer policies are published or updated.

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A 28-year-old patient is referred to a clinical laboratory after an abnormal prenatal screen and a family history of a hereditary metabolic disorder. The clinician orders a targeted molecular pathology test to evaluate a specific gene or set of exons for sequence variants and copy-number changes. The laboratory technologist performs the technical assay described by 81403—a Tier 2, Level 4 molecular pathology procedure—processing the specimen (blood or cultured cells), running the molecular analysis (for example, targeted DNA sequencing or deletion/duplication testing of a single gene region), and producing the raw technical data. The typical workflow includes specimen receipt and accessioning, DNA extraction, library preparation or targeted amplification, instrument run, primary data generation, and technical result reporting to the laboratory director. The professional component (interpretation and final sign-out) may be reported separately by a board-certified clinical molecular pathologist or geneticist using an appropriate professional CPT code or modifier. Typical site of service is a referenced clinical laboratory or hospital laboratory with molecular pathology capabilities. Common clinical indications include screening for chromosomal anomalies (Z13.79), evaluation of an unspecified chromosomal abnormality (Q99.9), investigation of a suspected metabolic disorder (E88.9), follow-up of abnormal urine findings (R82.90), or assessment after abnormal cardiovascular testing (R94.39).

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`81404`	Molecular pathology procedure, Level 5 (eg, analysis of 2-5 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 6-10 exons, or characterization of a dynamic mutation disorder/triplet repeat by Southern blot analysis)	Higher-level Tier 2 molecular pathology code used when the assay scope includes more exons or additional analytic complexity than `81403`; may be billed when the laboratory performs a more extensive targeted analysis

Related Modifiers

7 rows

Modifier	Description	When to Use
26	Modifier 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…
59	Modifier 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…
90	Modifier ‑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…
91	Modifier 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…
22	Modifier –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…
52	Modifier ‑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…
53	Modifier 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…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the labora…
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
207R00000X	Internal Medicine Physician	A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
208D00000X	General Practice Physician	A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
174M00000X	Veterinarian	A doctor of veterinary medicine, trained and authorized to practice veterinarian medicine and surgery.
133VN1004X	Pediatric Nutrition Registered Dietitian	An individual who is a Board Certified Specialist in Pediatric Nutrition and applies evidence-based nutrition knowledge in providing medical nutrition…
363LP0808X	Psychiatric/Mental Health Nurse Practitioner	Physician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner

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

CPT-81401-MOLECULAR-PATHOLOGY-TECHNICAL-LAB-ANALYSIS

CPT 81401: Tier 2, Level 2 Molecular Pathology Technical Test

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

CPT 81402: Molecular Pathology Tier 2 Level 3 Technical Test

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.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.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.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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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`81404`	Molecular pathology procedure, Level 5 (eg, analysis of 2-5 exons by DNA sequence analysis, mutation scanning or duplication/deletion variants of 6-10 exons, or characterization of a dynamic mutation disorder/triplet repeat by Southern blot analysis)	Higher-level Tier 2 molecular pathology code used when the assay scope includes more exons or additional analytic complexity than `81403`; may be billed when the laboratory performs a more extensive targeted analysis

Related Modifiers

7 rows

Modifier	Description	When to Use
26	Modifier 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…
59	Modifier 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…
90	Modifier ‑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…
91	Modifier 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…
22	Modifier –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…
52	Modifier ‑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…
53	Modifier 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…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the labora…
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
207R00000X	Internal Medicine Physician	A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
208D00000X	General Practice Physician	A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
174M00000X	Veterinarian	A doctor of veterinary medicine, trained and authorized to practice veterinarian medicine and surgery.
133VN1004X	Pediatric Nutrition Registered Dietitian	An individual who is a Board Certified Specialist in Pediatric Nutrition and applies evidence-based nutrition knowledge in providing medical nutrition…
363LP0808X	Psychiatric/Mental Health Nurse Practitioner	Physician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner

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

CPT-81401-MOLECULAR-PATHOLOGY-TECHNICAL-LAB-ANALYSIS

CPT 81401: Tier 2, Level 2 Molecular Pathology Technical Test

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

CPT 81402: Molecular Pathology Tier 2 Level 3 Technical Test

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.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.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.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.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

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

Sign up for cpt 81403 policy alerts

National Reimbursement Benchmarks

OpenPayer

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

Sign up for cpt 81403 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

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

Sign up for cpt 81403 policy alerts

National Reimbursement Benchmarks

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

Sign up for cpt 81403 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What does CPT 81403 represent and what part of the testing does it cover?

For what clinical scenarios is CPT 81403 commonly used?

When should a laboratory use a different related CPT code instead of 81403?

Where is CPT 81403 typically performed?

Does CPT 81403 include professional interpretation and final sign-out by a molecular pathologist?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What does CPT 81403 represent and what part of the testing does it cover?

For what clinical scenarios is CPT 81403 commonly used?

When should a laboratory use a different related CPT code instead of 81403?

Where is CPT 81403 typically performed?

Does CPT 81403 include professional interpretation and final sign-out by a molecular pathologist?

References