Summary & Overview
CPT 81432: Genomic Sequencing Panel for Hereditary Breast Cancer
CPT code 81432 represents a genomic sequencing panel designed to detect mutations in at least five genes linked to hereditary breast cancer. This advanced molecular diagnostic tool is increasingly important in clinical practice, offering comprehensive genetic insights that inform patient care and risk assessment. The code is widely recognized by major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, reflecting its clinical relevance and broad coverage.
This publication provides an in-depth overview of 81432, including payer coverage, clinical context, and related coding benchmarks. Readers will gain clarity on the scope of the procedure, typical laboratory settings, and its role in the evolving landscape of molecular pathology. Policy updates and coding trends are also discussed, helping stakeholders understand the implications for reimbursement and utilization. The analysis highlights the importance of genomic sequencing in hereditary breast cancer management and outlines how this code fits within broader laboratory and pathology services.
Key takeaways include payer coverage details, clinical applications, and the relationship of 81432 to other relevant CPT codes. The publication serves as a resource for understanding the national significance of this code in both clinical and billing contexts.
CPT Code Overview
CPT code 81432 is used for genomic sequence analysis panels that evaluate patient specimens for genetic sequences of at least five genes associated with hereditary breast cancer mutations. This procedure identifies both sequence variants and copy number variants, providing critical information for the diagnosis and management of hereditary breast cancer-related disorders. The service falls under Pathology and Laboratory Procedures – Genomic Sequencing Procedures and Other Molecular Multianalyte Assays and is typically performed in a laboratory setting (Place of Service 81).
Clinical & Coding Specifications
Clinical Context
A patient with a personal or family history suggestive of hereditary breast cancer presents to their healthcare provider. The provider orders a genomic sequencing panel to evaluate for mutations in at least five genes associated with hereditary breast cancer. The specimen is collected and sent to a laboratory (Place of Service 81) specializing in molecular genetics. The laboratory performs sequence analysis and copy number variant interrogation to identify pathogenic mutations. Results are interpreted by a medical geneticist and reported back to the provider for clinical management.
Coding Specifications
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Modifiers:
26: Professional Component – Used when only the interpretation of the test is performed by the provider, not the technical execution.TC: Technical Component – Used when only the technical execution of the test (e.g., running the assay) is performed, not the interpretation.
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Provider Taxonomies:
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