CPT 81419: Genomic Sequence Analysis Panel for Epilepsy

Commercial payers pay $2356 on average nationally for this procedure.

CPT code 81419 describes a laboratory genomic sequence analysis panel where the laboratory performs technical sequencing on a specimen (typically blood) to evaluate the genetic sequences of at least 24 specified genes; the test is used to help diagnose or indicate genetic predisposition to epilepsy. Service type: genetic/genomic diagnostic testing. Typical site of service: clinical laboratory or molecular diagnostics laboratory, specimen collected from outpatient or inpatient settings.

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 pricing for CPT 81419 centers on BUCA as the average commercial benchmark at $2,356.50, with individual national payers showing notable dispersion. Blue Cross Blue Shield posts the widest interquartile spread (P75–P25 = $1,280.50), reflecting more variability among higher-end contracts, while Aetna is the tightest (P75–P25 = $776.50). UnitedHealth Group and Cigna show intermediate spreads of $1,469.20 and $1,729.40 respectively, indicating broader variability across those networks.

Across payers the median and mean relationships highlight differing skew: Blue Cross Blue Shield and UnitedHealth Group have mean rates above their medians, suggesting higher outliers lift averages, whereas Aetna’s median exceeds its mean slightly. BUCA’s mean at $2,356.50 sits among the higher commercial means, serving as a useful central benchmark for national commercial pricing comparisons.

National Payer Mean Reimbursement Rates

State Reimbursement Rates

State: Alaska1 / 51

Rate by payer

Clinical & Coding Specifications

Clinical Context

A 6-year-old child with a history of recurrent, unprovoked seizures and developmental delay is referred to a pediatric neurologist. Prior electroencephalography (EEG) demonstrates epileptiform discharges; brain MRI is unrevealing for structural lesions. The neurologist orders a multi-gene epilepsy panel to evaluate for inherited causes that may guide prognosis and potential targeted therapy. A phlebotomy specimen (blood) is collected in an appropriate EDTA tube and sent to a clinical molecular genetics laboratory. The laboratory analyst performs 81419 testing: a genomic sequence analysis panel covering at least 24 genes associated with epilepsy. The workflow includes specimen accessioning, DNA extraction, library preparation, next-generation sequencing, bioinformatic alignment and variant calling, variant interpretation by a molecular pathologist, and generation of a clinical report. The report is routed to the ordering neurologist and entered into the electronic medical record. If clinically significant variants are identified, the ordering provider may coordinate genetic counseling and cascade testing for family members.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`81445`	Targeted genomic sequence analysis panel, solid organ neoplasm, DNA analysis, 5-50 genes	May be ordered instead of or in addition to `81419` when a focused tumor panel for somatic solid organ neoplasm genes is indicated; contrasts germline epilepsy panels.

Related Modifiers

9 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…
91	Modifier 91 — “Repeat Clinical Diagnostic Laboratory Test” — is appended when the exact same CPT laboratory test is performed more than once for the same patient on the same day because serial,…	- Use modifier 91 when the exact same CPT laboratory test is performed more than once on the same patient on the same date because serial or repeated testing is medically necessary to monitor…
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…
76	Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…	- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
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…
82	Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…	- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

Related Provider Taxonomies

8 rows

Taxonomy Code
207ZP0102X
207ZP0007X
207Q00000X
251E00000X
246QB0000X
3336N0007X
163WN0003X
317400000X

Related ICD-10-CM Codes

5 rows

ICD-10-CM Code	Description
C18.9	Malignant neoplasm of colon, unspecified
C34.90	Malignant neoplasm of unspecified part of unspecified bronchus or lung
C61	Malignant neoplasm of prostate
C25.9	Malignant neoplasm of pancreas, unspecified
C50.919	Malignant neoplasm of unspecified site of unspecified female breast

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

CPT 81418: Pharmacogenetic Multigene Panel Including CYP2C19 and CYP2D6

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
`81445`	Targeted genomic sequence analysis panel, solid organ neoplasm, DNA analysis, 5-50 genes	May be ordered instead of or in addition to `81419` when a focused tumor panel for somatic solid organ neoplasm genes is indicated; contrasts germline epilepsy panels.

Related Modifiers

9 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…
91	Modifier 91 — “Repeat Clinical Diagnostic Laboratory Test” — is appended when the exact same CPT laboratory test is performed more than once for the same patient on the same day because serial,…	- Use modifier 91 when the exact same CPT laboratory test is performed more than once on the same patient on the same date because serial or repeated testing is medically necessary to monitor…
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…
76	Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…	- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
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…
82	Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…	- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

Related Provider Taxonomies

8 rows

Taxonomy Code
207ZP0102X
207ZP0007X
207Q00000X
251E00000X
246QB0000X
3336N0007X
163WN0003X
317400000X

Related ICD-10-CM Codes

5 rows

ICD-10-CM Code	Description
C18.9	Malignant neoplasm of colon, unspecified
C34.90	Malignant neoplasm of unspecified part of unspecified bronchus or lung
C61	Malignant neoplasm of prostate
C25.9	Malignant neoplasm of pancreas, unspecified
C50.919	Malignant neoplasm of unspecified site of unspecified female breast

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

CPT 81418: Pharmacogenetic Multigene Panel Including CYP2C19 and CYP2D6

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 81419: Genomic Sequence Analysis Panel for Epilepsy

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National Reimbursement Benchmarks

CPT 81419: Genomic Sequence Analysis Panel for Epilepsy

Sign up for cpt 81419 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 81419 describe and where is it typically performed?

Which billing modifiers are commonly used or noted for CPT 81419?

What are the national commercial mean reimbursement benchmarks for CPT 81419 and how variable are they?

In what clinical scenarios is CPT 81419 used and what is the typical testing workflow?

Which payers commonly have coverage policies for CPT 81419 and how does it relate to other genetic tests?

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 81419 describe and where is it typically performed?

Which billing modifiers are commonly used or noted for CPT 81419?

What are the national commercial mean reimbursement benchmarks for CPT 81419 and how variable are they?

In what clinical scenarios is CPT 81419 used and what is the typical testing workflow?

Which payers commonly have coverage policies for CPT 81419 and how does it relate to other genetic tests?

References