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CPT 81417: Reanalysis of Existing Exome Sequence
CPT code 81417 covers the targeted clinical service of reanalyzing a previously generated exome sequence for an established patient when new clinical information or newly recognized conditions necessitate reinterpretation. This reanalysis can change diagnostic conclusions, affect patient management, or identify previously unrecognized pathogenic variants and is increasingly relevant as genomic databases and evidence evolve.
Key national payers included in this discussion are Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise description of the service and clinical context, comparisons to related exome sequencing codes, and an overview of payer coverage patterns and considerations that influence access to reanalysis services. The content highlights why reanalysis matters for precision medicine, including potential impacts on diagnosis and treatment selection.
The publication explains the clinical setting and workflow for reanalysis, typical indications for ordering CPT code 81417, and how it fits alongside initial exome sequencing codes used for diagnostic evaluation. Benchmarks and policy updates addressed in the piece include payer acceptance trends, coding relationships with initial sequencing services, and common administrative considerations that providers and laboratories encounter when submitting reanalysis claims. Data not available in the input are noted where applicable.
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Billing Code Overview
CPT code 81417 describes a reevaluation of an existing patient exome gene sequence when new information becomes available that was not part of the original analysis. This includes reanalysis prompted by updated clinical details or newly recognized findings unrelated to the initial indication. The service type is clinical genomic reanalysis of an existing exome sequence. The typical site of service is a clinical molecular genetics or clinical laboratory setting where genomic data are reviewed and interpreted by a laboratory analyst.
National Reimbursement Benchmarks
National commercial reimbursement for CPT 81417 clusters around BUCA’s average commercial rate of $331.70, with individual payer medians and means showing meaningful variation. Blue Cross Blue Shield (BCBS) and Cigna exhibit higher central tendencies (BCBS median $324.40, Cigna median $286.70) while Aetna and UnitedHealth Group trend lower in median and mean levels; this places BUCA’s average near the upper middle of the payer mix.
Dispersion measured by the interquartile spread (P75 minus P25) highlights differences in consistency: Blue Cross Blue Shield has the widest IQR at $107.30 (P75 $381.90 minus P25 $274.60), followed by Cigna at $253.40 (P75 $417.90 minus P25 $164.50) and BUCA at $140.60 (P75 $361.10 minus P25 $220.50). Aetna is the tightest at $116.40 (P75 $262.40 minus P25 $146.00), with UnitedHealth Group showing moderate spread of $176.00 (P75 $320.00 minus P25 $134.40).