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CPT 81404: Technical Component of Tier 2 Molecular Pathology
CPT code 81404 designates the technical laboratory testing component for a Tier 2, Level 5 molecular pathology procedure. It captures the work performed by the laboratory analyst to generate raw and processed data for one of the specific genetic analyses enumerated in this molecular pathology tier. This code matters nationally because molecular diagnostic testing increasingly informs oncology diagnosis, prognosis, and targeted therapy selection; consistent coding for technical services affects billing clarity, payer coverage decisions, and laboratory workflow alignment.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for Tier 2 molecular pathology services, typical sites of service, and how CPT code 81404 relates to adjacent molecular pathology procedure codes. The publication highlights common billing scenarios where only the technical component is reported, explains where 81404 fits within the Tier 2 code structure, and identifies related codes such as 81405 and 81479 for scope comparison.
The content provides operational benchmarks and policy-relevant considerations for national stakeholders — including payers, laboratory administrators, and coding professionals — covering utilization patterns, documentation touchpoints, and coding relationships that affect reimbursement and compliance. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 81404 describes a Tier 2, Level 5 molecular pathology procedure in which the laboratory analyst performs the technical laboratory tests required to complete a specified genetic analysis listed within this code. The description indicates a molecular genetic testing service focused on performing the laboratory (technical) component of a targeted genetic analysis.
Service type: Technical component of molecular pathology testing
Typical site of service: Clinical or reference laboratory performing molecular diagnostic testing
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.