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    v1.0.30
    OpenPayerBilling CodesGenomic Sequencing Procedures and Other Molecular Multianalyte AssaysCPT cpt-81420-nips-fetal-aneuploidy-sequencing-panel
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    CPT 81420: Cell-Free Fetal DNA Panel for Chromosomes 13, 18, 21

    Commercial payers pay $766 on average nationally for this procedure.

    CPT code 81420 describes a genomic sequence analysis panel performed on maternal plasma to evaluate circulating cell-free fetal DNA for genetic sequences on chromosomes 13, 18, and 21 to assess fetal chromosomal aneuploidy; this is a noninvasive prenatal screening service typically performed in a laboratory setting using maternal blood specimens and ordered as part of prenatal screening.

    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

    For CPT 81420 the national commercial landscape centers on a BUCA average of $766.40, with individual commercial payers showing meaningful dispersion in middle-to-upper percentiles. Blue Cross Blue Shield (BCBS) and Cigna exhibit higher median and upper-percentile concentrations, while Aetna and UnitedHealth Group sit lower on median values. BUCA’s quartiles ($524.80 to $847.70) place it near the upper-middle of the payer set, signaling that the average commercial environment for this code is elevated relative to some large national payers.

    Examining interquartile dispersion (P75 minus P25) highlights variation in pricing consistency: Blue Cross Blue Shield’s IQR is $228.80, Cigna’s is $595.40, BUCA’s is $322.90, Aetna’s is $299.40, and UnitedHealth Group’s is $370.30. Cigna therefore shows the widest IQR at $595.40, indicating the greatest middle-range variability, while Blue Cross Blue Shield has the tightest IQR at $228.80, indicating comparatively concentrated commercial rates.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 34-year-old pregnant woman presents at 10 weeks gestation for routine prenatal screening. Her obstetrician documents advanced maternal age and requests a noninvasive prenatal testing (NIPT) for common fetal aneuploidies. A blood draw is performed in the outpatient obstetrics clinic and the maternal plasma sample is sent to a reference molecular diagnostics laboratory. In the lab, a genomic sequence analysis panel targeting circulating cell-free fetal DNA is performed to assess chromosomal sequences associated with trisomies 13, 18, and 21. Results are reported to the ordering Obstetrics & Gynecology physician and, when applicable, discussed with a Genetic Counselor or Medical Geneticist. Follow-up actions may include targeted ultrasound, diagnostic testing (chorionic villus sampling or amniocentesis), and genetic counseling based on positive or high-risk findings.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    81228Cytogenomic constitutional (genome-wide) microarray analysisPerformed when a more comprehensive genome-wide copy number analysis is indicated after abnormal NIPT findings.
    81229Cytogenomic constitutional (genome-wide) microarray analysis; each additional microarray

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    26Modifier 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…
    59Modifier 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…
    90Modifier ‑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…
    91Modifier 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…
    62Modifier 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…
    52Modifier ‑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…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207VG0400X
    207SG0201X
    207SG0202X
    207ZP0007X
    207ZB0001X
    207RB0002X
    2084B0040X
    226000000X

    Related ICD-10-CM Codes

    31 rows

    ICD-10-CM CodeDescription
    O09.41Supervision of pregnancy with grand multiparity, first trimester
    O09.511Supervision of elderly primigravida, first trimester
    O09.512Supervision of elderly primigravida, second trimester
    O09.513Supervision of elderly primigravida, third trimester
    O09.521Supervision of elderly multigravida, first trimester
    O09.522Supervision of elderly multigravida, second trimester
    O09.523Supervision of elderly multigravida, third trimester
    O09.611Supervision of young primigravida, first trimester
    O09.612Supervision of young primigravida, second trimester
    O09.613Supervision of young primigravida, third trimester

    Showing 1–10 of 31

    Related Payer Policy Updates

    Specialty: Genetic & Molecular Testing1 / 3

    10 rows

    PolicyPayerEffective Date
    Oral Cancer Screening and TestingOscar Health2027-01-01
    RTM Testing for Alpha-1 Antitrypsin DeficiencyOscar Health2027-01-01
    Cytochrome P450 Genotype-Guided Treatment Strategy Corporate Medical Policybcbsvermont2027-01-01
    Carrier Testing Panels for Genetic Diseases (for Kentucky Only)UnitedHealthcare2026-10-01
    Genetic Testing for Neurological Disorders (for Kansas Only)UnitedHealthcare2026-10-01
    Genetic and Molecular TestingProvidence Health Plan2026-10-01
    Cell-Free Fetal DNA Testing (for Idaho Only)UnitedHealthcare2026-10-01
    Next Generation Sequencing for Minimal Residual Disease DetectionProvidence Health Plan2026-10-01
    Pharmacogenetic Panel Testing (for Kansas Only)UnitedHealthcare2026-10-01
    Non-Covered Genetic Panel TestsProvidence Health Plan2026-10-01

    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-81419-GENOMIC-SEQUENCE-PANEL-EPILEPSY

    CPT 81419: Genomic Sequence Analysis Panel for Epilepsy

    Showing 1–10 of 43

    Frequently Asked Questions

    References

    1. 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. 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. 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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    Billed when multiple microarray analyses are performed for the same patient/sample as part of expanded diagnostic workup.
    81479Unlisted molecular pathology procedureUsed when a specific molecular test related to fetal aneuploidy does not have a specific CPT code and a custom reportable procedure is required.
    81507Fetal aneuploidy DNA sequence analysis of selected regions using maternal plasmaAlternative or complementary NIPT methodology; may be billed when the assay targets selected regions rather than genome-wide sequencing.