CPT 81431: STRC/GJB2/GJB6 Copy Number and Deletion Panel

Commercial payers pay $696 on average nationally for this procedure.

CPT code 81431 describes a molecular pathology panel performed by a laboratory analyst to detect copy number changes in the STRC and DFNB1 genes and deletions in the GJB2 and GJB6 genes, assessing genetic causes of hereditary hearing loss; service type: targeted genetic copy number and deletion analysis; typical site of service: outpatient clinical laboratory or molecular diagnostics laboratory performing gene panel testing.

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National Reimbursement Benchmarks

The national commercial landscape for CPT 81431 centers around a BUCA average commercial rate of $696.40, with notable variation among individual payers. Blue Cross Blue Shield displays the highest dispersion between its 25th and 75th percentiles (range $250.00: $805.50 minus $555.50), while Aetna and UnitedHealth Group show relatively tighter interquartile spreads of $246.00 ($557.20 - $323.10) and $426.00 ($679.60 - $285.40) respectively. Cigna's interquartile spread is $504.50 ($880.10 - $347.60), indicating substantial variability within its contracted rates.

Beyond dispersion, mean and median relationships differ by payer: Blue Cross Blue Shield and Cigna have mean rates ($810.70 and $660.70) above their medians, suggesting right-skewed distributions, whereas UnitedHealth Group's mean ($541.80) sits above a lower median ($407.70) indicating a longer high-end tail. Aetna’s mean ($429.70) aligns closer to its median ($462.00), implying a more symmetric distribution around its center.

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CPT 81431: STRC/GJB2/GJB6 Copy Number and Deletion Panel

Commercial payers pay $696 on average nationally for this procedure.

Customize your policy alerts

Sign up for cpt 81431 policy alerts

Get alerted when payer policies referencing 81431 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A pediatric or adult patient presents for evaluation of sensorineural hearing loss, a family history of hereditary hearing impairment, or as part of a genetic screening for congenital hearing disorders. The ordering clinician (often a clinical geneticist, otolaryngologist, or pediatrician) documents hearing impairment or a family history and requests a targeted molecular panel. The laboratory receives a blood or saliva specimen, verifies patient and order information, extracts DNA, and performs copy-number analysis of STRC and DFNB1 loci and targeted deletion testing for GJB2 and GJB6 using validated methods (e.g., multiplex PCR, MLPA, or next-generation sequencing CNV algorithms). The lab analyst interprets detected copy-number variants and deletions, correlates findings with clinical information, and issues a report indicating pathogenic, likely pathogenic, variants of uncertain significance, or negative results with recommendations for variant confirmation or reflex testing if needed. Typical turnaround time may range from days to a few weeks depending on reflex testing. Typical sites of service include outpatient genetic testing laboratories, hospital-based molecular diagnostics labs, and reference laboratories supporting otolaryngology and genetics clinics.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`81220`	CFTR gene analysis; full gene sequence	Performed for patients with suspected cystic fibrosis; may be ordered concurrently if clinical features overlap or for differential genetic evaluation
`81221`	CFTR gene analysis; known familial variants	Used when testing targets known familial CFTR variants; may be ordered instead of full sequencing when family variants are known
`81222`	CFTR gene analysis; duplication/deletion variants	Detects copy-number changes in CFTR; conceptually similar CNV testing approach as used for `STRC` deletions
`81479`	Unlisted molecular pathology procedure	Used when a performed molecular test does not have a specific CPT code; may be used for novel or custom panels not otherwise described

Related Modifiers

6 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…
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…
53	Modifier 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…
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…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207SG0201X	Clinical Genetics (M.D.) Physician	A clinical geneticist demonstrates competence in providing comprehensive diagnostic, management and counseling services for genetic disorders.
207SG0202X	Clinical Biochemical Genetics Physician	A clinical biochemical geneticist demonstrates competence in performing and interpreting biochemical analyses relevant to the diagnosis and management…
207SG0205X	Ph.D. Medical Genetics Physician	A medical geneticist works in association with a medical specialist, is affiliated with a clinical genetics program and serves as a consultant to medi…
332S00000X	Hearing Aid Equipment	The manufacture and/or sale of electronic hearing aids, their component parts, and related products and services on a national basis.
347C00000X	Private Vehicle	An individual paid to provide non-emergency transportation using their privately owned/leased vehicle.
261QM1300X	Multi-Specialty Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
163WA2000X	Administrator Registered Nurse	Nursing Service Providers · Registered Nurse
364SW0102X	Women's Health Clinical Nurse Specialist	Physician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist

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.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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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`81220`	CFTR gene analysis; full gene sequence	Performed for patients with suspected cystic fibrosis; may be ordered concurrently if clinical features overlap or for differential genetic evaluation
`81221`	CFTR gene analysis; known familial variants	Used when testing targets known familial CFTR variants; may be ordered instead of full sequencing when family variants are known
`81222`	CFTR gene analysis; duplication/deletion variants	Detects copy-number changes in CFTR; conceptually similar CNV testing approach as used for `STRC` deletions
`81479`	Unlisted molecular pathology procedure	Used when a performed molecular test does not have a specific CPT code; may be used for novel or custom panels not otherwise described

Related Modifiers

6 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…
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…
53	Modifier 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…
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…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
207SG0201X	Clinical Genetics (M.D.) Physician	A clinical geneticist demonstrates competence in providing comprehensive diagnostic, management and counseling services for genetic disorders.
207SG0202X	Clinical Biochemical Genetics Physician	A clinical biochemical geneticist demonstrates competence in performing and interpreting biochemical analyses relevant to the diagnosis and management…
207SG0205X	Ph.D. Medical Genetics Physician	A medical geneticist works in association with a medical specialist, is affiliated with a clinical genetics program and serves as a consultant to medi…
332S00000X	Hearing Aid Equipment	The manufacture and/or sale of electronic hearing aids, their component parts, and related products and services on a national basis.
347C00000X	Private Vehicle	An individual paid to provide non-emergency transportation using their privately owned/leased vehicle.
261QM1300X	Multi-Specialty Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
163WA2000X	Administrator Registered Nurse	Nursing Service Providers · Registered Nurse
364SW0102X	Women's Health Clinical Nurse Specialist	Physician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist

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.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 81431: STRC/GJB2/GJB6 Copy Number and Deletion Panel

Sign up for cpt 81431 policy alerts

National Reimbursement Benchmarks

CPT 81431: STRC/GJB2/GJB6 Copy Number and Deletion Panel

Sign up for cpt 81431 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What does CPT 81431 cover and where is this testing typically performed?

Which billing modifiers are applicable to CPT 81431 and what do they indicate?

What reimbursement benchmarks are reported for CPT 81431 and how variable are payer rates?

In what clinical situations is the 81431 panel typically ordered and which clinicians usually order it?

Are there related CPT codes to consider alongside 81431 and when might they be relevant?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What does CPT 81431 cover and where is this testing typically performed?

Which billing modifiers are applicable to CPT 81431 and what do they indicate?

What reimbursement benchmarks are reported for CPT 81431 and how variable are payer rates?

In what clinical situations is the 81431 panel typically ordered and which clinicians usually order it?

Are there related CPT codes to consider alongside 81431 and when might they be relevant?

References