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CPT 81405: Molecular Pathology Technical Laboratory Testing
CPT code 81405 denotes the technical laboratory work for a specified Tier 2, Level 6 molecular pathology analysis. It captures the lab-based analytic processes performed by a laboratory analyst to generate results for targeted genetic testing. This code matters nationally because molecular diagnostic testing informs diagnosis, treatment selection, and disease monitoring across hematologic malignancies and other genetic conditions; accurate coding of the technical component affects billing clarity and laboratory workflow recognition.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for use of 81405, common payer coverage patterns, and how this code relates to other molecular pathology codes used for targeted sequence analysis. The publication highlights benchmarks for application of the technical component, typical sites of service, and common clinical indications associated with related hematologic ICD-10 diagnoses.
The content provides operational clarity rather than clinical recommendations. It explains when 81405 is the appropriate technical-service code, contrasts it with closely related Tier 1 testing codes where relevant, and outlines the practical implications for laboratory billing and claims submission. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 81405 describes a technical laboratory procedure in which a lab analyst performs the technical laboratory testing necessary to complete one of the specific genetic analyses listed in a Tier 2, Level 6 molecular pathology code. This service represents the technical component of targeted molecular diagnostic testing and is typically performed in clinical pathology or molecular diagnostics laboratories. The service type is molecular pathology — technical laboratory testing, and the typical site of service is a clinical or reference laboratory.
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.