Summary & Overview
CPT 81418: Pharmacogenomic Drug Metabolism Genomic Sequence Analysis Panel
CPT code 81418 represents a comprehensive pharmacogenomic panel for drug metabolism, requiring analysis of at least six genes, including detailed variant and duplication/deletion analysis for CYP2C19 and CYP2D6. This code is significant nationally as it supports precision medicine by informing clinicians about individual patient responses to medications, potentially improving therapeutic outcomes and reducing adverse drug reactions. The procedure is typically performed in independent laboratories and is classified under genomic sequencing and molecular multianalyte assays.
Major payers such as Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare provide coverage for this service, reflecting its growing importance in clinical practice and payer policy. Readers will gain insights into payer coverage benchmarks, recent policy updates, and the clinical context for pharmacogenomic testing. The publication also addresses relevant coding practices, associated diagnoses, and related CPT codes, offering a comprehensive overview for stakeholders in laboratory medicine, billing, and healthcare policy.
CPT Code Overview
CPT code 81418 is used for drug metabolism genomic sequence analysis panels, specifically in the context of pharmacogenomics. This procedure involves testing at least six genes, including variant analysis for CYP2C19 and CYP2D6, as well as duplication and deletion analysis for CYP2D6. The service falls under Pathology and Laboratory Procedures – Genomic Sequencing Procedures and Other Molecular Multianalyte Assays. The typical site of service for this code is an Independent Laboratory (Place of Service 81). This testing provides valuable information for understanding how patients metabolize medications, supporting personalized medicine approaches.
Clinical & Coding Specifications
Clinical Context
A patient is referred to an independent laboratory for pharmacogenomic testing to guide drug therapy decisions. The patient has a diagnosis of a solid organ tumor, such as a renal cell carcinoma (C64.1*, C64.2*), or a neuroendocrine tumor (C7A.093*). The ordering physician requests a genomic sequence analysis panel to assess drug metabolism, specifically including at least six genes, with mandatory analysis of CYP2C19 and CYP2D6 variants, as well as CYP2D6 duplication/deletion. The results will inform medication selection and dosing, particularly for drugs metabolized by these enzymes. The laboratory performs the sequencing and reports findings to the provider, who integrates the results into the patient's treatment plan.
Coding Specifications
- Modifier
59: Indicates a distinct procedural service. Used when the drug metabolism genomic sequence analysis panel (81418) is performed separately from other procedures, ensuring proper reporting of independent services.
| Modifier Code | Description |
|---|