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    v1.0.28
    OpenPayerBilling CodesCPT cpt-81433-molecular-genetic-testing-deleted-2025
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    CPT 81433: Molecular Genetic Test Panel (Deleted 2025)

    Commercial payers pay $488 on average nationally for this procedure.

    CPT code 81433 (Deleted effective January 1, 2025) represented a molecular genetic test panel for detecting genomic alterations associated with hereditary and somatic tumors, used for genetic analysis of pancreatic and certain breast malignancies; service type: molecular/pathology genetic testing; typical site of service: clinical laboratory or pathology reference lab.

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    National Reimbursement Benchmarks

    Blue Cross Blue Shield, Cigna, UnitedHealth Group and BUCA present a wide commercial rate landscape for CPT 81433, with BUCA representing the average-commercial benchmark at $488.30. Cigna posts one of the higher central tendencies (median $640.40) while Blue Cross Blue Shield centers lower (median $351.10). UnitedHealth Group’s median ($460.90) sits between Blue Cross Blue Shield and Cigna, indicating variability in how national commercial payers value this code.

    Dispersion measured as P75 minus P25 highlights variability differences: Blue Cross Blue Shield’s spread is $99.70 (P75 $417.00 minus P25 $307.30), BUCA’s spread is $115.10 (P75 $505.80 minus P25 $390.70), Cigna’s spread is $131.10 (P75 $640.40 minus P25 $509.30), and UnitedHealth Group shows the widest spread at $109.80 (P75 $548.70 minus P25 $438.90). Cigna and BUCA show wider interquartile spreads, while Blue Cross Blue Shield is relatively tighter by this measure.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Clinical & Coding Specifications

    Clinical Context

    A patient with a newly diagnosed or suspected pancreatic or related intra-abdominal malignancy is referred for molecular diagnostic testing to guide targeted therapy and hereditary cancer evaluation. Typical scenario: a 62-year-old patient with obstructive jaundice and imaging showing a mass in the pancreatic head undergoes endoscopic ultrasound with fine-needle aspiration; formal pathology confirms pancreatic adenocarcinoma. The clinician orders comprehensive somatic or germline molecular testing to identify actionable mutations (for example, BRCA1/2, mismatch repair genes, KRAS, or other targets) and to assess eligibility for targeted therapies or clinical trials. Specimen types include formalin‑fixed paraffin‑embedded tumor tissue from surgical resection or core biopsy, cytology cell block from fine‑needle aspiration, or peripheral blood for germline testing. The laboratory workflow includes specimen accessioning, DNA/RNA extraction, library preparation, next‑generation sequencing or deletion/duplication analysis, bioinformatic variant calling, interpretation by molecular pathologists, and generation of a clinical report. Results are transmitted to the ordering oncologist or surgical team and incorporated into multidisciplinary tumor board discussion for treatment planning.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    81479Unlisted molecular pathology procedure (used for duplication/deletion analysis panel for hereditary breast cancer‑related disorders)Related as a panel-based molecular analysis for copy-number or deletion/duplication detection; may be ordered as complementary hereditary testing when germline predisposition is suspected.

    Related Modifiers

    6 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…
    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…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    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…
    56Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianA pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the labora…
    207ZP0105XClinical Pathology/Laboratory Medicine PhysicianA pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the labora…
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    163WD1100XPeritoneal Dialysis Registered NurseNursing Service Providers · Registered Nurse
    2279S1500XSNF/Subacute Care Registered Respiratory TherapistCare of residents in a long-term care environment. Respiratory modalities delivered include those similar in the general care and critical care areas…
    163WA0400XAddiction (Substance Use Disorder) Registered NurseNursing Service Providers · Registered Nurse
    207YP0228XPediatric Otolaryngology PhysicianA pediatric otolaryngologist has special expertise in the management of infants and children with disorders that include congenital and acquired condi…
    227900000XRegistered Respiratory TherapistA Registered Respiratory Therapist (RRT) is an advanced therapist who has passed standardized written and clinical simulation examinations administere…

    Related ICD-10-CM Codes

    11 rows

    ICD-10-CM CodeDescription
    C48.1Malignant neoplasm of specified parts of peritoneum
    C25.0Malignant neoplasm of head of pancreas
    C25.1Malignant neoplasm of body of pancreas
    C25.2Malignant neoplasm of tail of pancreas
    C25.3Malignant neoplasm of pancreatic duct
    C25.4Malignant neoplasm of endocrine pancreas
    C25.7Malignant neoplasm of other parts of pancreas
    C25.8Malignant neoplasm of overlapping sites of pancreas
    C50.011Malignant neoplasm of nipple and areola, right female breast
    C50.012Malignant neoplasm of nipple and areola, left female breast

    Showing 1–10 of 11

    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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