CPT 81405: Tier 2 Level 6 Molecular Pathology Lab Test
Commercial payers pay $293 on average nationally for this procedure.
CPT code 81405 describes a Tier 2, Level 6 molecular pathology service in which a laboratory analyst performs the technical laboratory testing needed to complete a specific targeted genetic analysis; the service type is molecular pathology — technical laboratory processing and the typical site of service is clinical laboratory or pathology laboratory where sequencing or targeted genetic assays are run.
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
National commercial reimbursement for CPT 81405 centers on a BUCA average commercial rate of $293, with individual payers showing notable differences in central tendency and upper-tail values. Blue Cross Blue Shield posts a higher median and mean compared with BUCA ($291.20 median, $322.10 mean), while Cigna and Aetna show higher mean rates ($383.20 and $168.20 respectively for Cigna and Aetna), and UnitedHealth Group’s median ($180.80) is below the BUCA average. Maximums vary substantially across payers, with Cigna and Blue Cross Blue Shield exhibiting particularly high upper-end values, indicating pockets of elevated negotiated pricing.
Rate dispersion (P75 minus P25) highlights variability in contract spread: Blue Cross Blue Shield’s interquartile range is $154.0 ($370.0 - $216.0), Cigna’s is $281.3 ($440.1 - $160.8), UnitedHealth Group’s is $173.8 ($301.4 - $126.6), Aetna’s is $136.0 ($241.0 - $105.0), and BUCA’s is $175.3 ($348.7 - $173.4). Cigna shows the widest IQR at $281.3, signaling the largest middle-50% dispersion, while Aetna is the tightest at $136.0.