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CPT 81418: Pharmacogenomic Multigene Drug-Metabolism Panel
Headline: Newborns to geriatrics increasingly receive pharmacogenomic testing — CPT code 81418 enables multigene drug-metabolism profiling.
Lead: CPT code 81418 documents a pharmacogenomic panel that examines at least six genes, including mandatory CYP2C19 and CYP2D6 variant and duplication/deletion analysis, to inform medication selection and dosing. The test is nationally relevant as precision prescribing expands across specialties.
What CPT code 81418 represents and why it matters: The code captures multigene pharmacogenomic testing specifically aimed at genes influencing therapeutic drug metabolism. As precision medicine grows, these tests can reduce adverse drug reactions and improve therapeutic efficacy by tailoring drug choice and dose to genetic profiles.
Key payers covered in this analysis: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Overview of what readers will learn: This publication reviews the clinical context of multigene pharmacogenomic testing, payer coverage landscape and benchmarks, coding and billing considerations related to CPT code 81418, and links to related molecular and unlisted genetic test codes. Readers will find concise guidance on common sites of service, typical clinical use cases, and how CPT code 81418 connects to laboratory workflows and reporting practices.
Policy and clinical context: The summary frames CPT code 81418 within broader trends in personalized medicine and laboratory diagnostics. Data not available in the input regarding specific reimbursement rates and utilization metrics.
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Billing Code Overview
CPT code 81418 describes a pharmacogenomic panel that evaluates a blood or saliva specimen for genetic variants in at least six genes that can affect drug metabolism. The test must include analysis of CYP2C19 and CYP2D6 variants and must include CYP2D6 duplication/deletion analysis. Clinicians may use results to help determine appropriate medication selection and dosing.
Service Type: Pharmacogenomic (multigene) testing
Typical Site of Service: Clinical laboratory or outpatient specimen collection site
National Reimbursement Benchmarks
Commercial rates for CPT 81418 cluster around BUCA’s average commercial benchmark of $860.20, with notable variation across major payers. Blue Cross Blue Shield’s distribution skews higher with a median of $871.20 and a long tail to a max of $3,053.90, while Cigna and Aetna show elevated means of $852.50 and $605.20 respectively. UnitedHealth Group’s mean is lower at $729.20 and its median sits below BUCA’s average at $550.30. These contrasts indicate a market where BUCA sits near the center of commercial pricing but payers diverge meaningfully at the top end.
Dispersion measured by the interquartile range (P75–P25) highlights where rates are tightest and widest: Aetna’s IQR is $258.00, Cigna’s IQR is $648.10, Blue Cross Blue Shield’s IQR is $270.30, BUCA’s IQR is $375.00, and UnitedHealth Group’s IQR is $535.90. Cigna exhibits the widest IQR at $648.10, reflecting the greatest mid‑range variability, while Aetna is the tightest at $258.00, indicating more concentrated commercial reimbursement around its central range.