CPT 81422 Reimbursement & Benchmarks | OpenPayer

Summary & Overview

CPT 81422: Genomic Sequence Analysis for Fetal Chromosomal Microdeletions

CPT code 81422 represents a genomic sequence analysis panel designed to detect chromosomal microdeletions in circulating cell–free fetal DNA from maternal blood. This advanced molecular assay is crucial for early identification of conditions such as DiGeorge syndrome and Cri–du–chat syndrome, offering significant clinical value in prenatal care. The code is widely recognized across major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, reflecting its importance in coverage and reimbursement policies.

This publication provides a comprehensive overview of 81422, detailing its clinical applications, payer coverage landscape, and relevant benchmarks. Readers will gain insight into current policy updates, utilization trends, and the broader context of genomic sequencing in prenatal screening. The analysis also highlights associated service types, typical laboratory settings, and related procedural codes, equipping stakeholders with essential information for understanding the role of this test in modern maternal-fetal medicine.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcare81422Genomic SequencingPathology and Laboratory ProceduresPrenatal ScreeningChromosomal MicrodeletionsCell-free Fetal DNADiGeorge SyndromeCri-du-chat SyndromeLaboratory TestingMolecular Assays

CPT Code Overview

CPT code 81422 is used for genomic sequence analysis panels that evaluate circulating cell–free fetal DNA in maternal blood for chromosomal microdeletion(s). This testing is associated with conditions such as DiGeorge syndrome and Cri–du–chat syndrome. The procedure falls under the category of Pathology and Laboratory Procedures, specifically Genomic Sequencing Procedures and Other Molecular Multianalyte Assays. The typical site of service for this test is a laboratory, designated as Place of Service 81.

Clinical & Coding Specifications

Clinical Context

A pregnant patient presents for non-invasive prenatal testing during the first trimester. The clinical workflow involves collecting a maternal blood sample to evaluate circulating cell–free fetal DNA for chromosomal microdeletion syndromes, such as DiGeorge or Cri–du–chat. The test is performed in a laboratory setting (POS 81) and is typically ordered by an obstetrics & gynecology physician, genetic counselor, or medical geneticist. The results assist in antenatal screening and maternal care planning for suspected chromosomal abnormalities in the fetus.

Coding Specifications

Modifiers:
- 26: Professional Component – Used when only the interpretation of the test is performed by the provider.
- TC: Technical Component – Used when only the technical aspect (e.g., sample processing, analysis) is performed.
Provider Taxonomies:

Code Specialty
207SG0201X

Code	Specialty
`207SG0201X`

National Reimbursement Benchmarks

National mean rates for CPT code 81422 among commercial payers are notably higher than typical Medicare rates, with the BUCA (average commercial) mean rate at $623.28. Individual commercial payers such as Blue Cross Blue Shield ($671.89), Cigna ($677.55), and UnitedHealth Group ($604.04) all report mean rates above $600, while Aetna is slightly lower at $584.86. Medicare rates are not available in the input for comparison.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Cigna exhibits the widest spread at $543.52, indicating substantial variability in reimbursement. UnitedHealth Group has the tightest range at $371.00, suggesting more consistent rates. Blue Cross Blue Shield and Aetna show moderate dispersion, with ranges of $237.00 and $244.00, respectively. The BUCA average has a range of $295.04.

The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.

81455 – Solid organ or hematolymphoid neoplasm or disorder, 51 or greater genes, genomic sequence analysis panel, interrogation for sequence variants and copy number variants or rearrangements, or isoform expression or mRNA expression levels, if performed

81416-CYP2C19-CYTOCHROME-P450-FAMILY-2-SUBFAMILY-C-POLYPEPTIDE-19

81416 – CYP2C19 (cytochrome P450, family 2, subfamily C, polypeptide 19) (e.g., drug metabolism), gene analysis, common variants (e.g., *2, *3, *4, *5, *6, *7, *8, *17)

81447-TARGETED-GENOMIC-SEQUENCE-ANALYSIS-PANEL-SOLID-ORGAN

81447 – Targeted genomic sequence analysis panel, solid organ neoplasm, DNA analysis, 5-50 genes

81469-HEREDITARY-BREAST-CANCERRELATED-DISORDERS-EG-HEREDITARY

81469 – Hereditary breast cancer-related disorders (e.g., hereditary breast and ovarian cancer, hereditary breast cancer-related disorders), genomic sequence analysis panel, must include sequencing of at least 14 genes (e.g., ATM, BRCA1, BRCA2, CDH1, CHEK2, PALB2, PTEN, STK11, and TP53)

81477-MOLECULAR-PATHOLOGY-PROCEDURE-LEVEL-9-EG-ANALYSIS-OF-1125

CPT 81477: Molecular Pathology Procedure, Level 9 DNA Sequence Analysis

81408-TIER-2-MOLECULAR-PATHOLOGY-PROCEDURES-LEVEL

CPT 81408: Advanced Molecular Pathology Laboratory Procedure

81410-GENOMIC-SEQUENCING-PROCEDURE-HERITABLE-THORACIC-AORTIC

CPT 81410: Genomic Sequencing for Heritable Thoracic Aortic Disease

81429-GENOMIC-SEQUENCE-ANALYSIS-PANEL-SOLID-ORGAN-NEOPLASM-DNA

CPT 81429: Genomic Sequence Analysis Panel for Solid Organ Neoplasms

81463-TARGETED-GENOMIC-SEQUENCE-ANALYSIS-PANEL-SOLID-ORGAN

CPT 81463: Targeted Genomic Sequence Analysis Panel for Solid Organ Neoplasms

81440-

CPT 81440: Genomic Sequencing Procedures and Multianalyte Assays