CPT 81416: Relative Exome Sequence Analysis for Reference Exome
Commercial payers pay $10978 on average nationally for this procedure.
CPT code 81416 describes laboratory analysis in which an exome from a relative is sequenced to create a reference exome that is compared with the patient’s exome to evaluate an unexplained genetic disorder or syndrome; this is a molecular diagnostic service typically performed as a laboratory-based exome sequencing analysis with the site of service most often being an outpatient clinical laboratory or specialized molecular genetics laboratory.
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National Reimbursement Benchmarks
National commercial reimbursement for CPT 81416 centers around BUCA’s mean commercial rate of $10,978.30, which serves as an indicative market average. Among large payers, Blue Cross Blue Shield’s mean is higher at $12,579 with a notable high outlier max of $73,877.10, while Cigna and Aetna cluster around $11,653.50 and $5,311 respectively; UnitedHealth Group’s mean is $9,567.80. These figures indicate a multi-thousand-dollar spread in commercial compensation for this genetic test across payer contracts.
Dispersion measured by interquartile range (P75–P25) highlights variability: Blue Cross Blue Shield is tightest with a range of $5,018.35, UnitedHealth Group is relatively narrow at $6,960.00, and BUCA’s IQR is $6,488.00. Cigna and Aetna show wider spreads of $9,372.10 and $8,600.00 respectively, signaling greater inconsistency in negotiated commercial rates with those payers.