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CPT 81406: Molecular Pathology Technical Lab Analysis
CPT code 81406 designates a Tier 2, Level 7 molecular pathology technical procedure in which a laboratory analyst performs the technical laboratory testing to complete a specified genetic analysis. This code captures the analytic work component of higher-complexity genetic assays and is used nationally to report the laboratory’s technical contribution to molecular diagnostic testing. Accurate use of this code affects claims processing, lab-level reporting, and coding consistency for genetic testing services.
Key payers in scope for national coverage and coding practice include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical and billing definition, comparisons with related molecular pathology codes, and the typical service settings where the technical component is delivered. The publication also outlines common ICD-10 clinical contexts in which the code is reported and notes associated laboratory taxonomies.
This summary provides clinicians, laboratory billing staff, and policy analysts with concise context about when CPT code 81406 is used, its role within multi-component molecular testing, and the payer landscape relevant to national coding and reimbursement discussions.
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Billing Code Overview
CPT code 81406 describes a technical laboratory procedure performed by a lab analyst to complete one of the specific genetic analyses listed in this Tier 2, Level 7 molecular pathology code. The service represents the laboratory-based analytic work required to run a molecular pathology test included at this level.
Service Type: Molecular pathology — technical component
Typical Site of Service: Clinical laboratory or hospital laboratory
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.