CPT 81417: Exome Reanalysis for New Clinical Information

Commercial payers pay $332 on average nationally for this procedure.

CPT code 81417 describes a laboratory reanalysis of an existing patient exome sequencing result when new clinical information or previously unavailable evidence emerges; this service is a targeted reinterpretation of prior exome data to reassess variant classification and clinical significance. The service type is exome reanalysis / reinterpretation and the typical site of service is clinical molecular diagnostics laboratory performing genomic data review and reporting.

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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).

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CPT 81417: Exome Reanalysis for New Clinical Information

Commercial payers pay $332 on average nationally for this procedure.

Customize your policy alerts

Sign up for cpt 81417 policy alerts

Get alerted when payer policies referencing 81417 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient with a prior clinical exome sequencing report for evaluation of a suspected hereditary cancer predisposition (initial test performed two years earlier) presents after new clinical developments: progression of an indeterminate lung lesion and new family history revealing a first-degree relative with early-onset colon cancer. The laboratory receives a written request from the ordering oncologist to perform a reanalysis of the previously generated exome sequence data (not a repeat sequencing run) to assess whether newly published variant classifications, updated population frequency data, or additional phenotype information change the interpretation of previously reported variants.

The clinical workflow: the laboratory confirms access to the archived raw sequence and variant call files for the patient, documents the updated clinical information and family history in the lab information system, and performs bioinformatic reannotation using current databases (ClinVar, gnomAD, locus-specific databases) and updated interpretation guidelines (ACMG/AMP). The lab analyst evaluates any newly reported or reclassified variants, prepares an amended/updated report describing variant reclassification, clinical significance, and potential implications for targeted therapy or surveillance, and communicates results to the ordering oncologist. Billing uses 81417 for the reanalysis service, with appropriate modifier selection and supporting notes in the report indicating the new information that prompted reanalysis.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`81416`	Exome sequence analysis in a relative to create a reference exome for comparison	Performed when a family member's exome is sequenced to assist interpretation of variants in the proband; may precede or accompany `81417` reanalysis if a new reference exome becomes available.
`81415`	Exome sequence analysis to look for genetic changes explaining an unexplained disorder or syndrome	Represents initial diagnostic exome sequencing; `81417` is used for subsequent reanalysis of that prior exome when new information arises.
`81418`	Pharmacogenomic panel (≥6 genes including CYP2C19 and CYP2D6)	Distinct targeted pharmacogenomic testing that may be ordered separately to guide therapy; not a substitute for `81417` but may be ordered in parallel for therapeutic decision-making.

Related Modifiers

7 rows

Modifier	Description	When to Use
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
90	Modifier ‑90 (Reference/Outside Laboratory) indicates that a laboratory test was performed by an entity other than the treating or reporting provider. The American Medical Association defines…	- Use CPT modifier -90 when a laboratory test is performed by an outside/reference laboratory (an entity other than the treating or reporting physician or qualified professional) and the claim needs…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the labora…
207ZP0007X	Molecular Genetic Pathology (Pathology) Physician	A molecular genetic pathologist is expert in the principles, theory and technologies of molecular biology and molecular genetics. This expertise is us…
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
2278P3800X	Palliative/Hospice Certified Respiratory Therapist	A coordinated plan of care to help dying patients and their families handle the burden of terminal care. Effective secretion management and relief of…
310400000X	Assisted Living Facility	A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitorin…
207UN0903X	In Vivo & In Vitro Nuclear Medicine Physician	A nuclear medicine physician who specializes in in vivo and in vitro nuclear medicine.
293D00000X	Physiological Laboratory	A laboratory that operates independently of a hospital and physician's office to furnish physiological diagnostic services (e.g. EEG's , EKG's, scans,…
261QA1903X	Ambulatory Surgical Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center

Related ICD-10-CM Codes

28 rows

ICD-10-CM Code	Description
C18.9	Malignant neoplasm of colon, unspecified
C25.9	Malignant neoplasm of pancreas, unspecified
C34.90	Malignant neoplasm of unspecified part of unspecified bronchus or lung
C50.919	Malignant neoplasm of unspecified site of unspecified female breast
C61	Malignant neoplasm of prostate
C79.9	Secondary malignant neoplasm of unspecified site
C90.00	Multiple myeloma not having achieved remission
D82.1	Di George's syndrome
D82.9	Immunodeficiency associated with major defect, unspecified
E78.5	Hyperlipidemia, unspecified

Showing 1–10 of 28

Related Codes

CPT-81410-GENOMIC-PANEL-AORTIC-DISEASE

CPT 81410: Heritable Thoracic Aortic Disease Targeted Gene Panel

CPT-81411-GENETIC-DUPLICATION-DELETION-PANEL-AORTIC-DISEASE

CPT 81411: Genetic Panel for Aortic Dysfunction Copy Number Analysis

CPT-81412-ASHKENAZI-JEWISH-GENOMIC-SEQUENCE-PANEL

CPT 81412: Ashkenazi Jewish–Associated Genetic Sequence Panel

CPT-81413-GENOMIC-PANEL-CARDIAC-ION-CHANNELOPATHIES

CPT 81413: Cardiac Ion Channelopathy Targeted Gene Panel

CPT-81414-CARDIAC-ION-CHANNELOPATHY-CNV-PANEL

CPT 81414: Cardiac Ion Channelopathy Copy Number Variant Panel

CPT-81415-EXOME-SEQUENCE-ANALYSIS-UNEXPLAINED-DISORDER

CPT 81415: Exome Sequence Analysis for Unexplained Disorder

CPT-81416-FAMILIAL-EXOME-SEQUENCE-ANALYSIS

CPT 81416: Relative Exome Sequence Analysis for Reference Exome

CPT-81418-PHARMACOGENOMIC-MULTIGENE-DRUG-METABOLISM-PANEL

CPT 81418: Pharmacogenetic Multigene Panel Including CYP2C19 and CYP2D6

CPT-81419-GENOMIC-SEQUENCE-PANEL-EPILEPSY

CPT 81419: Genomic Sequence Analysis Panel for Epilepsy

CPT-81420-NIPS-FETAL-ANEUPLOIDY-SEQUENCING-PANEL

CPT 81420: Cell-Free Fetal DNA Panel for Chromosomes 13, 18, 21

Showing 1–10 of 43

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`81416`	Exome sequence analysis in a relative to create a reference exome for comparison	Performed when a family member's exome is sequenced to assist interpretation of variants in the proband; may precede or accompany `81417` reanalysis if a new reference exome becomes available.
`81415`	Exome sequence analysis to look for genetic changes explaining an unexplained disorder or syndrome	Represents initial diagnostic exome sequencing; `81417` is used for subsequent reanalysis of that prior exome when new information arises.
`81418`	Pharmacogenomic panel (≥6 genes including CYP2C19 and CYP2D6)	Distinct targeted pharmacogenomic testing that may be ordered separately to guide therapy; not a substitute for `81417` but may be ordered in parallel for therapeutic decision-making.

Related Modifiers

7 rows

Modifier	Description	When to Use
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
90	Modifier ‑90 (Reference/Outside Laboratory) indicates that a laboratory test was performed by an entity other than the treating or reporting provider. The American Medical Association defines…	- Use CPT modifier -90 when a laboratory test is performed by an outside/reference laboratory (an entity other than the treating or reporting physician or qualified professional) and the claim needs…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the labora…
207ZP0007X	Molecular Genetic Pathology (Pathology) Physician	A molecular genetic pathologist is expert in the principles, theory and technologies of molecular biology and molecular genetics. This expertise is us…
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
2278P3800X	Palliative/Hospice Certified Respiratory Therapist	A coordinated plan of care to help dying patients and their families handle the burden of terminal care. Effective secretion management and relief of…
310400000X	Assisted Living Facility	A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitorin…
207UN0903X	In Vivo & In Vitro Nuclear Medicine Physician	A nuclear medicine physician who specializes in in vivo and in vitro nuclear medicine.
293D00000X	Physiological Laboratory	A laboratory that operates independently of a hospital and physician's office to furnish physiological diagnostic services (e.g. EEG's , EKG's, scans,…
261QA1903X	Ambulatory Surgical Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center

Related ICD-10-CM Codes

28 rows

ICD-10-CM Code	Description
C18.9	Malignant neoplasm of colon, unspecified
C25.9	Malignant neoplasm of pancreas, unspecified
C34.90	Malignant neoplasm of unspecified part of unspecified bronchus or lung
C50.919	Malignant neoplasm of unspecified site of unspecified female breast
C61	Malignant neoplasm of prostate
C79.9	Secondary malignant neoplasm of unspecified site
C90.00	Multiple myeloma not having achieved remission
D82.1	Di George's syndrome
D82.9	Immunodeficiency associated with major defect, unspecified
E78.5	Hyperlipidemia, unspecified

Showing 1–10 of 28

Related Codes

CPT-81410-GENOMIC-PANEL-AORTIC-DISEASE

CPT 81410: Heritable Thoracic Aortic Disease Targeted Gene Panel

CPT-81411-GENETIC-DUPLICATION-DELETION-PANEL-AORTIC-DISEASE

CPT 81411: Genetic Panel for Aortic Dysfunction Copy Number Analysis

CPT-81412-ASHKENAZI-JEWISH-GENOMIC-SEQUENCE-PANEL

CPT 81412: Ashkenazi Jewish–Associated Genetic Sequence Panel

CPT-81413-GENOMIC-PANEL-CARDIAC-ION-CHANNELOPATHIES

CPT 81413: Cardiac Ion Channelopathy Targeted Gene Panel

CPT-81414-CARDIAC-ION-CHANNELOPATHY-CNV-PANEL

CPT 81414: Cardiac Ion Channelopathy Copy Number Variant Panel

CPT-81415-EXOME-SEQUENCE-ANALYSIS-UNEXPLAINED-DISORDER

CPT 81415: Exome Sequence Analysis for Unexplained Disorder

CPT-81416-FAMILIAL-EXOME-SEQUENCE-ANALYSIS

CPT 81416: Relative Exome Sequence Analysis for Reference Exome

CPT-81418-PHARMACOGENOMIC-MULTIGENE-DRUG-METABOLISM-PANEL

CPT 81418: Pharmacogenetic Multigene Panel Including CYP2C19 and CYP2D6

CPT-81419-GENOMIC-SEQUENCE-PANEL-EPILEPSY

CPT 81419: Genomic Sequence Analysis Panel for Epilepsy

CPT-81420-NIPS-FETAL-ANEUPLOIDY-SEQUENCING-PANEL

CPT 81420: Cell-Free Fetal DNA Panel for Chromosomes 13, 18, 21

Showing 1–10 of 43

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.