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CPT 81407: Molecular Pathology Technical Test, Tier 2 Level 8
CPT code 81407 represents the technical component of a Tier 2, Level 8 molecular pathology procedure in which a laboratory analyst performs the laboratory testing needed to complete a specified genetic analysis. Nationally, this code captures a high-complexity laboratory activity central to genetic diagnostics, carrier screening, and targeted sequencing workflows. Its use affects laboratory billing classifications and aggregation of molecular pathology service volumes across payers.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage and payment policies for molecular pathology technical services vary by payer and can influence laboratory contracting, claim adjudication, and coding practice consistency.
Readers will find a concise overview of the clinical role of CPT code 81407, how it maps to molecular pathology service lines and typical laboratory settings, and context for related testing such as fetal aneuploidy sequencing (see related code 81507). The publication also summarizes common payer coverage considerations and coding patterns, offers benchmarks for utilization where available, and highlights policy and documentation elements that affect claim processing for high-complexity genetic technical services.
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Billing Code Overview
CPT code 81407 describes a Tier 2, Level 8 molecular pathology technical service in which a laboratory analyst performs the technical laboratory testing necessary to complete one of the specific genetic analyses listed under this molecular pathology tier. The service represents the technical component of a complex genetic test workflow and is performed by trained laboratory personnel.
Service Type: Molecular pathology — technical component (laboratory test performance)
Typical Site of Service: Clinical laboratory or reference laboratory
National Reimbursement Benchmarks
National commercial reimbursement for CPT 81407 clusters around the BUCA average commercial rate of $900.20, with individual payers showing distinct central tendencies: Blue Cross Blue Shield centers near a higher median ($896.90) and Cigna and Aetna show elevated means driven by higher maximums. UnitedHealth Group’s median of $507.80 sits well below BUCA and most peers, indicating lower typical payments from that carrier.
Dispersion (P75 minus P25) highlights variability: Blue Cross Blue Shield has a range of $309.10 ($1,086.60 - $747.50) and Cigna shows the widest interquartile spread at $781.70 ($1,234.70 - $453.00). UnitedHealth Group is among the tightest with a range of $491.00 ($846.30 - $355.40), while Aetna’s interquartile range is $341.50 ($846.30 - $480.00). These differences point to meaningful payer-by-payer volatility in commercial reimbursement levels.