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.
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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.