CPT Code Overview

CPT code 81406 represents a Tier 2 Molecular Pathology Procedure, encompassing specialized laboratory tests for specific analytes not individually listed in Tier 1. These procedures are typically performed in an independent laboratory setting, designated as Place of Service 81. The service type is molecular pathology, which involves advanced genetic and molecular testing to aid in diagnosis, risk assessment, and treatment planning. These tests are essential for identifying genetic mutations, chromosomal anomalies, and other molecular markers relevant to patient care.

Clinical Context

A patient is referred to an independent laboratory for molecular pathology testing to evaluate for potential genetic or chromosomal anomalies. The ordering provider may be a family medicine physician or a specialist in pathology. The laboratory performs a Tier 2 molecular pathology procedure, which involves testing for specific analytes not individually listed in Tier 1. The results may inform diagnosis, screening, or genetic counseling, and are typically used in cases where there is a family history of genetic disease, suspicion of metabolic disorders, or the need for chromosomal abnormality screening. The workflow includes specimen collection, laboratory analysis, and interpretation by a qualified pathologist.

Coding Specifications

• Modifiers:

  • Modifier 26: Used to indicate the professional component of the service, such as interpretation of laboratory results by a physician or pathologist.
  • Modifier TC: Used to indicate the technical component, which covers the laboratory's performance of the test, including equipment and staff.

• Provider Taxonomies:

  Code	Specialty