Summary & Overview
CPT 81416: CYP2C19 Gene Analysis, Common Variants
Headline: CYP2C19 Genetic Panel (CPT 81416) Assesses Drug Metabolism Variants with Growing Clinical Relevance
Lead: CPT 81416 designates a genetic analysis for common variants in the CYP2C19 gene, a pharmacogenomic marker with implications for medication selection and dosing across multiple therapeutic areas. The test informs clinicians about metabolizer status that can influence response to drugs such as certain antiplatelet agents and psychotropics.
What this code represents and why it matters: CPT 81416 captures gene-level testing for CYP2C19 variants that alter enzymatic activity. Nationally, pharmacogenomic testing like this is increasingly integrated into precision prescribing initiatives to reduce adverse events and optimize efficacy.
Key payers covered: The analysis addresses coverage considerations across major commercial plans, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.
Overview of what readers will learn: The publication provides a concise policy and billing synthesis for CPT 81416, including typical clinical indications, expected laboratory setting, common ICD-10 diagnosis links, related molecular pathology codes, and modifier usage. Readers will find benchmarking context for how this genetic test is positioned among related CYP panels and unlisted molecular pathology codes, plus practical notes on billing components and where to locate additional coding guidance. Data gaps: Service line metadata is not available in the input.
CPT Code Overview
CPT 81416 is a genetic test that analyzes common variants in the CYP2C19 gene, which encodes a cytochrome P450 enzyme involved in drug metabolism. This assay identifies clinically relevant alleles (for example, *2, *3, *4, *5, *6, *7, *8, *17) that can affect how patients metabolize certain medications.
Service Type: Genetic Testing
Typical Site of Service: Laboratory (POS 81)
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient taking clopidogrel after percutaneous coronary intervention is referred for pharmacogenomic testing to assess CYP2C19 common variant status. A clinician orders the test to evaluate drug metabolism affecting antiplatelet therapy selection and dosing. The specimen is collected in the outpatient clinic and sent to a commercial molecular diagnostics laboratory (POS 81). The laboratory performs targeted genotyping for common CYP2C19 variants (for example *2, *3, *17) and issues a report that is routed to the ordering provider for medication management decisions.
Coding Specifications
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Modifiers
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26— Professional component: Use when billing for the interpretation and reporting performed by a qualified professional (e.g., pathologist or clinical geneticist) separate from the laboratory technical work. -
TC— Technical component: Use when billing for the laboratory technical work, including specimen processing, reagents, instrumentation, and raw data generation. -
Associated provider taxonomies and specialties
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