CPT 81418: Pharmacogenetic Multigene Panel Including CYP2C19 and CYP2D6

Commercial payers pay $860 on average nationally for this procedure.

CPT code 81418 describes a pharmacogenetic multigene panel performed on blood or saliva to detect clinically relevant variants in six or more genes that affect drug metabolism; the test must include CYP2C19 and CYP2D6 variant analysis plus CYP2D6 duplication/deletion analysis and is used to inform medication selection and dosing. Service type: genetic testing / molecular pathology. Typical site of service: clinical laboratory or outpatient specimen collection.

For related coverage guidance, see recent payer policy updates: Oral Cancer Screening and Testing, RTM Testing for Alpha-1 Antitrypsin Deficiency, Cytochrome P450 Genotype-Guided Treatment Strategy Corporate Medical Policy.

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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.

National Payer Mean Reimbursement Rates

State Reimbursement Rates

State: Alaska1 / 51

Rate by payer

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient with a history of recurrent depressive disorder and poorly controlled chronic pain is scheduled for medication optimization after multiple adverse drug effects and inadequate therapeutic response. The treating oncologist and clinical pharmacist coordinate with a molecular diagnostics laboratory to perform pharmacogenomic testing on a blood specimen to evaluate variants in multiple pharmacokinetic genes, including obligatory analysis of CYP2C19 and CYP2D6 (with duplication/deletion analysis for CYP2D6). Results will inform selection and dosing of antidepressants, opioids, and other medications metabolized by these enzymes. The clinical workflow includes: pre-test counseling and informed consent; collection of a blood or saliva specimen in the clinic; test requisition with relevant clinical indication and ICD-10 code; laboratory processing with targeted genotyping or sequencing of at least six genes; result interpretation by molecular pathology; and a follow-up clinic visit where the prescribing clinician reviews actionable variants and documents medication changes in the medical record.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`81225`

Related Modifiers

8 rows

Modifier	Description	When to Use
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…
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…
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…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
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…
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…
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…

Related Provider Taxonomies

8 rows

Taxonomy Code
207ZP0102X
207ZP0007X
207L00000X
261QS0132X
2086S0127X
207VB0002X
163WP0809X
163WM1400X

Related ICD-10-CM Codes

31 rows

ICD-10-CM Code	Description
C25.4*
C64.1*
C64.2*
C65.1*
C65.2*
C66.1*
C66.2*
C67.0*
C67.1*
C67.2*

Showing 1–10 of 31

Related Payer Policy Updates

Specialty: Genetic & Molecular Testing1 / 3

10 rows

Policy	Payer	Effective Date
Oral Cancer Screening and Testing	Oscar Health	2027-01-01
RTM Testing for Alpha-1 Antitrypsin Deficiency	Oscar Health	2027-01-01
Cytochrome P450 Genotype-Guided Treatment Strategy Corporate Medical Policy	bcbsvermont	2027-01-01
Carrier Testing Panels for Genetic Diseases (for Kentucky Only)	UnitedHealthcare	2026-10-01
Genetic Testing for Neurological Disorders (for Kansas Only)	UnitedHealthcare	2026-10-01
Genetic and Molecular Testing	Providence Health Plan	2026-10-01
Cell-Free Fetal DNA Testing (for Idaho Only)	UnitedHealthcare	2026-10-01
Next Generation Sequencing for Minimal Residual Disease Detection	Providence Health Plan	2026-10-01
Pharmacogenetic Panel Testing (for Kansas Only)	UnitedHealthcare	2026-10-01
Non-Covered Genetic Panel Tests	Providence Health Plan	2026-10-01

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-81417-EXOME-SEQUENCE-REEVALUATION

CPT 81417: Exome Reanalysis for New Clinical Information

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

Frequently Asked Questions

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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State Reimbursement Rates

State: Alaska1 / 51

Rate by payer

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`81225`

Related Modifiers

8 rows

Modifier	Description	When to Use
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…
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…
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…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
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…
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…
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…

Related Provider Taxonomies

8 rows

Taxonomy Code
207ZP0102X
207ZP0007X
207L00000X
261QS0132X
2086S0127X
207VB0002X
163WP0809X
163WM1400X

Related ICD-10-CM Codes

31 rows

ICD-10-CM Code	Description
C25.4*
C64.1*
C64.2*
C65.1*
C65.2*
C66.1*
C66.2*
C67.0*
C67.1*
C67.2*

Showing 1–10 of 31

Related Payer Policy Updates

Specialty: Genetic & Molecular Testing1 / 3

10 rows

Policy	Payer	Effective Date
Oral Cancer Screening and Testing	Oscar Health	2027-01-01
RTM Testing for Alpha-1 Antitrypsin Deficiency	Oscar Health	2027-01-01
Cytochrome P450 Genotype-Guided Treatment Strategy Corporate Medical Policy	bcbsvermont	2027-01-01
Carrier Testing Panels for Genetic Diseases (for Kentucky Only)	UnitedHealthcare	2026-10-01
Genetic Testing for Neurological Disorders (for Kansas Only)	UnitedHealthcare	2026-10-01
Genetic and Molecular Testing	Providence Health Plan	2026-10-01
Cell-Free Fetal DNA Testing (for Idaho Only)	UnitedHealthcare	2026-10-01
Next Generation Sequencing for Minimal Residual Disease Detection	Providence Health Plan	2026-10-01
Pharmacogenetic Panel Testing (for Kansas Only)	UnitedHealthcare	2026-10-01
Non-Covered Genetic Panel Tests	Providence Health Plan	2026-10-01

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-81417-EXOME-SEQUENCE-REEVALUATION

CPT 81417: Exome Reanalysis for New Clinical Information

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

Frequently Asked Questions

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.

CPT 81418: Pharmacogenetic Multigene Panel Including CYP2C19 and CYP2D6

Sign up for cpt 81418 policy alerts

National Reimbursement Benchmarks

CPT 81418: Pharmacogenetic Multigene Panel Including CYP2C19 and CYP2D6

Sign up for cpt 81418 policy alerts

National Reimbursement Benchmarks

State Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

What does CPT 81418 cover and which genes are required?

Where is CPT 81418 typically performed and how does it fit into clinical workflow?

Are there related CPT or proprietary codes I should be aware of when billing CPT 81418?

Which billing modifiers are commonly relevant for CPT 81418?

What reimbursement benchmarks and payer variability are reported for CPT 81418?

References

State Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

What does CPT 81418 cover and which genes are required?

Where is CPT 81418 typically performed and how does it fit into clinical workflow?

Are there related CPT or proprietary codes I should be aware of when billing CPT 81418?

Which billing modifiers are commonly relevant for CPT 81418?

What reimbursement benchmarks and payer variability are reported for CPT 81418?

References