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    v1.0.30
    OpenPayerBilling CodesTier 2 Molecular Pathology ProceduresCPT cpt-81406-molecular-pathology-technical-lab-analysis
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    CPT 81406: Molecular Pathology Tier 2, Level 7 Technical Component

    Commercial payers pay $295 on average nationally for this procedure.

    CPT code 81406 describes a molecular pathology Tier 2, Level 7 procedure where a laboratory analyst performs the technical component of a specific genetic analysis to generate raw molecular data; service type is molecular pathology testing (technical component) and the typical site of service is a clinical laboratory or pathology lab performing specialized genetic testing.

    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 81406 centers on a BUCA average commercial rate of $295.00, with substantial variation among major payers. Blue Cross Blue Shield (BCBS) and Cigna show higher central tendency figures—BCBS median $294.70 and Cigna median $294.80—while Aetna and UnitedHealth Group sit lower at medians of $99.70 and $169.70, respectively. This positions BUCA’s mean near the upper-mid range of payer medians, indicating that average commercial contracts tend to cluster above Aetna’s typical levels but below Cigna’s occasional high outliers.

    Rate dispersion (P75 minus P25) highlights where contractual spreads are tightest and widest: UnitedHealth Group has the tightest interquartile spread at $165.10 ($282.90 - $118.80), followed by Aetna at $160.00 ($226.00 - $59.00). The widest spreads occur with Cigna at $282.00 ($435.30 - $152.30) and BCBS at $145.20 ($353.60 - $207.40) when compared by absolute IQRs, reflecting greater variability in commercial pricing for those payers relative to others.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 28-year-old patient attends a genetic counseling visit after a family history reveals a known inherited disorder. The clinician documents an indication for targeted molecular analysis to detect specific gene variants or chromosomal findings. A clinical laboratory receives the specimen (blood or buccal swab) and the lab analyst performs the technical testing associated with a Tier 2, Level 7 molecular pathology test described by 81406. The typical workflow: the ordering provider (often a family medicine physician or genetic counselor) places the order with diagnosis code Z31.430 for genetic counseling or Z13.79 for genetic screening; the specimen is collected in an outpatient clinic or ambulatory surgical center and sent to a clinical pathology laboratory; the laboratory technical staff run the specified molecular assay, generate raw and interpreted results, and the medical director/pathologist reviews and releases the report. Results are returned to the ordering provider for counseling and any follow-up management. Typical site of service is an outpatient clinical laboratory or hospital laboratory performing diagnostic molecular testing. Common payer interactions involve prior authorization for genetic tests and submission of the technical component billed under the laboratory performing 81406 with appropriate modifiers to reflect billing circumstances.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure

    Related Modifiers

    7 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…
    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…
    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…
    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…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207ZP0102X
    207L00000X
    207Q00000X
    311Z00000X
    2082S0105X
    385HR2065X
    103TC2200X
    1835G0000X

    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-81404-TIER-2-MOLECULAR-PATHOLOGY-TECHNICAL-COMPONENT

    CPT 81404: Molecular Pathology Technical Laboratory Procedure

    CPT-81405-MOLECULAR-PATHOLOGY-TECHNICAL-LAB-TESTING

    CPT 81405: Tier 2 Level 6 Molecular Pathology Lab Test

    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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    81407Molecular pathology procedure, Level 8Higher complexity molecular pathology procedure; may be performed for broader or more complex analyses when 81406 is insufficient.
    81220CFTR gene analysisSpecific gene test for cystic fibrosis; may be ordered alongside tiered molecular testing workflows where 81406 represents a component-level assay.
    81225CYP2C19 gene analysisPharmacogenomic test that can be performed in the same molecular laboratory; ordered when medication metabolism guidance is needed in addition to genetic screening.
    81230CYP2D6 gene analysisPharmacogenomic test commonly run in molecular labs; may be part of a panel or separate order where 81406 denotes the technical procedure for one listed Tier 2 assay.