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    v1.0.30
    OpenPayerBilling CodesTier 2 Molecular Pathology ProceduresCPT cpt-81404-tier-2-molecular-pathology-technical-component
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    CPT 81404: Molecular Pathology Technical Laboratory Procedure

    Commercial payers pay $265 on average nationally for this procedure.

    CPT code 81404 describes a Tier 2, Level 5 molecular pathology service in which a laboratory analyst performs the technical component to run specific genetic tests; the service type is molecular pathology technical testing and the typical site of service is a clinical or hospital-based molecular diagnostics laboratory where laboratory personnel process specimens and generate raw test data for downstream analysis.

    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

    Commercial rates for CPT 81404 center around BUCA’s average commercial benchmark of $264.50, with notable variation across major national payers. Blue Cross Blue Shield shows one of the widest interquartile spreads (P75–P25 = $339.90 - $204.50 = $135.40), and Cigna also exhibits substantial dispersion (P75–P25 = $401.20 - $142.30 = $258.90), reflecting a broad range of negotiated payments. Aetna and UnitedHealth Group present tighter mid‑range spreads; Aetna’s P75–P25 equals $219.00 - $104.90 = $114.10, while UnitedHealth Group’s equals $274.80 - $115.40 = $159.40, indicating more concentrated but still meaningful variability.

    Median and mean relationships further illustrate market differences: Cigna and Blue Cross Blue Shield have higher mean and median levels (means of $307.00 and $300.10 respectively), while Aetna’s mean is lower at $160.80. UnitedHealth Group’s median of $164.90 sits below BUCA’s average, suggesting BUCA’s $264.50 average commercial rate is above several national payer medians but below some payer means driven by high upper‑end rates.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 58-year-old patient with newly diagnosed acute myelogenous leukemia (C92.00) presents to the hematology-oncology clinic after bone marrow biopsy. The treating hematologist requests a Tier 2, Level 5 molecular pathology test to detect specific somatic mutations and structural variants that affect prognosis and targeted therapy selection. A peripheral blood or bone marrow specimen is sent to the molecular pathology laboratory. The lab analyst performs the technical sequencing, data generation, and primary bioinformatic processing specified by 81404 to produce variant calls. The laboratory pathologist reviews and signs out the interpreted report. Results are relayed to the ordering hematologist for integration into the treatment plan and potential referral to clinical trials.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    81405Tier 2 Molecular Pathology Procedure; full gene sequence or targeted sequence analysis of > 5 exons of TP53 and duplication/deletion analysis for MEN1Another Tier 2 molecular pathology code representing a different analyte or analytic complexity that may be ordered for parallel somatic or germline testing.

    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…
    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…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    291U00000X
    207ZP0007X
    207Q00000X
    163WG0600X
    2080T0002X
    174N00000X
    322D00000X
    207RI0001X

    Related ICD-10-CM Codes

    28 rows

    ICD-10-CM CodeDescription
    C92.00Acute myeloblastic leukemia, not having achieved remission
    C92.02Acute myeloblastic leukemia, in relapse
    C92.30Myeloid sarcoma, not having achieved remission
    C92.32Myeloid sarcoma, in relapse
    C92.40Acute promyelocytic leukemia, not having achieved remission
    C92.42Acute promyelocytic leukemia, in relapse
    C92.50Acute myelomonocytic leukemia, not having achieved remission
    C92.52Acute myelomonocytic leukemia, in relapse
    C92.60Acute myeloid leukemia with 11q23-abnormality not having achieved remission
    C92.62Acute myeloid leukemia with 11q23-abnormality in relapse

    Showing 1–10 of 28

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

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

    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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    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.

    81406
    RET (ret‑proto‑oncogene) full gene sequence (non‑covered)
    Related as an example of a Tier 2 full gene sequence; not typically covered but reflects alternate targeted sequencing assays.
    81479Unlisted molecular pathology procedure (use when analyte not represented by existing Tier 1 or Tier 2 codes)Used when a requested molecular assay is not represented by 81404 or other Tier codes; may be used if a novel analyte or custom panel is performed.