CPT 81434: Retinal Disorders Genomic Sequence Analysis Panel

Commercial payers pay $559 on average nationally for this procedure.

CPT code 81434 describes a laboratory-performed genomic sequence analysis panel that evaluates a patient specimen for genetic variants across a set of at least 15 genes associated with retinal disorders, representing clinical molecular diagnostic testing typically performed as a multigene next-generation sequencing panel; the service type is genetic testing / genomic sequence analysis and the typical site of service is a clinical diagnostic laboratory or reference molecular genetics laboratory where specimens are processed and sequenced.

Customize your policy alerts

Sign up for cpt 81434 policy alerts

Get alerted when payer policies referencing 81434 are released or updated.

Monitor payer policy activity

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

National Reimbursement Benchmarks

Commercial rates for CPT 81434 center around BUCA’s mean of $558.80 as a proxy for average commercial reimbursement; several large national payers trade around that level but with meaningful spread. Blue Cross Blue Shield’s interquartile spread (P75–P25) is $713.40, and Cigna’s IQR is $511.20, both notably wider than BUCA’s IQR of $344.10. Aetna and UnitedHealth Group show tighter mid‑range dispersion: Aetna’s IQR is $238.10 and UnitedHealth Group’s IQR is $346.80, indicating more consistency near their medians. Comparing extremes, Blue Cross Blue Shield exhibits the widest interquartile dispersion, suggesting greater variability in contracted commercial rates, while Aetna is the tightest among the payers listed. Published median and mean differences also reflect that Cigna and Blue Cross Blue Shield push higher upper quartiles, whereas Aetna and UnitedHealth Group cluster more closely around middle values.

Explore openpayer tools

View all tools

CPT 81434: Retinal Disorders Genomic Sequence Analysis Panel

Commercial payers pay $559 on average nationally for this procedure.

Customize your policy alerts

Sign up for cpt 81434 policy alerts

Get alerted when payer policies referencing 81434 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 34-year-old female with a personal history of early-onset breast cancer and a strong family history of breast and ovarian cancer is referred to a medical genetics clinic for comprehensive hereditary cancer testing. The clinician orders a multi-gene genomic sequencing panel focused on retinal disorder genes listed under 81434 because the patient has concurrent unexplained retinal dystrophy symptoms and a complex family history that may include syndromic associations affecting both ocular and breast/ovarian risk. A peripheral blood specimen is collected in the outpatient clinic and sent to a CLIA-certified molecular diagnostics laboratory. The laboratory performs next-generation sequencing (NGS) covering at least the 15 retinal disorder-related genes specified by the 81434 descriptor, including sequence variant detection and reporting of pathogenic, likely pathogenic, and variants of uncertain significance. The report is reviewed by a board-certified clinical molecular geneticist or genetic counselor, who provides interpretation and documents implications for patient management and family testing.

Typical workflow steps:

Referral and pretest genetic counseling in outpatient genetics or ophthalmology clinic
Collection of specimen (blood) in the clinic and shipment to reference molecular laboratory
Laboratory performs genomic sequence analysis panel for retinal disorder genes per 81434
Laboratory quality control, variant interpretation, and generation of clinical report
Results returned to ordering provider; post-test counseling and coordination of cascade testing as indicated

Typical site of service: outpatient clinic or ambulatory surgical center for specimen collection and reference molecular laboratory for analysis.

Typical patient scenario: symptomatic patient with retinal dystrophy plus family history of hereditary cancer or carrier status concerns, or a patient undergoing broader genetic assessment where retinal gene panel is indicated alongside hereditary cancer gene testing.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`81211`	BRCA1 and BRCA2 analysis; targeted sequence analysis	May be ordered alongside `81434` when hereditary breast/ovarian cancer risk assessment is required in the same patient
`81213`	BRCA1 and BRCA2 analysis; full gene sequence	Alternative or complementary hereditary cancer testing when full sequencing of BRCA genes is indicated in the clinical workup
`81432`	Hereditary breast cancer-related disorders, genomic sequence analysis panel	Clinically related panel frequently ordered in parallel with retinal or syndromic panels when there is overlap in family cancer history
`81433`	Hereditary breast cancer-related disorders, duplication/deletion analysis panel	Performed when copy number variants in BRCA1/BRCA2 are suspected in addition to sequencing panels like `81434`
`81435`	Hereditary colon cancer disorders, genomic sequence analysis panel	Another hereditary cancer panel that may be part of a broader genomic evaluation when multiple cancer predisposition syndromes are considered

Related Modifiers

8 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…
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…
62	Modifier 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…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
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…

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.
207SC0300X	Clinical Cytogenetics Physician	A clinical cytogeneticist demonstrates competence in providing laboratory diagnostic and clinical interpretive services dealing with cellular componen…
207SG0202X	Clinical Biochemical Genetics Physician	A clinical biochemical geneticist demonstrates competence in performing and interpreting biochemical analyses relevant to the diagnosis and management…
207SG0203X	Clinical Molecular Genetics Physician	A clinical molecular geneticist demonstrates competence in performing and interpreting molecular analyses relevant to the diagnosis and management of …
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…
276400000X	Substance Use Disorder Rehabilitation Hospital Unit	A distinct part of a hospital that provides medically monitored, interdisciplinary addiction-focused treatment to patients/clients who have psychoacti…
2086S0102X	Surgical Critical Care Physician	A surgeon with expertise in the management of the critically ill and postoperative patient, particularly the trauma victim, who specializes in critica…
103TM1800X	Intellectual & Developmental Disabilities Psychologist	Behavioral Health & Social Service Providers · Psychologist

Related ICD-10-CM Codes

20 rows

ICD-10-CM Code	Description
C50.919	Malignant neoplasm of unspecified site of unspecified female breast
E70.0	Classical phenylketonuria
E83.39	Other disorders of phosphorus metabolism
E88.09	Other disorders of plasma-protein metabolism, not elsewhere classified
G71.3	Mitochondrial myopathy, not elsewhere classified
H26.9	Unspecified cataract
H31.9	Unspecified disorder of choroid
H35.50	Unspecified hereditary retinal dystrophy
H35.52	Pigmentary retinal dystrophy
H35.53	Other dystrophies primarily involving the sensory retina

Showing 1–10 of 20

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.

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.

Explore openpayer tools

View all tools

Clinical & Coding Specifications

Clinical Context

Typical workflow steps:

Referral and pretest genetic counseling in outpatient genetics or ophthalmology clinic
Collection of specimen (blood) in the clinic and shipment to reference molecular laboratory
Laboratory performs genomic sequence analysis panel for retinal disorder genes per 81434
Laboratory quality control, variant interpretation, and generation of clinical report
Results returned to ordering provider; post-test counseling and coordination of cascade testing as indicated

Typical site of service: outpatient clinic or ambulatory surgical center for specimen collection and reference molecular laboratory for analysis.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`81211`	BRCA1 and BRCA2 analysis; targeted sequence analysis	May be ordered alongside `81434` when hereditary breast/ovarian cancer risk assessment is required in the same patient
`81213`	BRCA1 and BRCA2 analysis; full gene sequence	Alternative or complementary hereditary cancer testing when full sequencing of BRCA genes is indicated in the clinical workup
`81432`	Hereditary breast cancer-related disorders, genomic sequence analysis panel	Clinically related panel frequently ordered in parallel with retinal or syndromic panels when there is overlap in family cancer history
`81433`	Hereditary breast cancer-related disorders, duplication/deletion analysis panel	Performed when copy number variants in BRCA1/BRCA2 are suspected in addition to sequencing panels like `81434`
`81435`	Hereditary colon cancer disorders, genomic sequence analysis panel	Another hereditary cancer panel that may be part of a broader genomic evaluation when multiple cancer predisposition syndromes are considered

Related Modifiers

8 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…
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…
62	Modifier 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…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
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…

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.
207SC0300X	Clinical Cytogenetics Physician	A clinical cytogeneticist demonstrates competence in providing laboratory diagnostic and clinical interpretive services dealing with cellular componen…
207SG0202X	Clinical Biochemical Genetics Physician	A clinical biochemical geneticist demonstrates competence in performing and interpreting biochemical analyses relevant to the diagnosis and management…
207SG0203X	Clinical Molecular Genetics Physician	A clinical molecular geneticist demonstrates competence in performing and interpreting molecular analyses relevant to the diagnosis and management of …
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…
276400000X	Substance Use Disorder Rehabilitation Hospital Unit	A distinct part of a hospital that provides medically monitored, interdisciplinary addiction-focused treatment to patients/clients who have psychoacti…
2086S0102X	Surgical Critical Care Physician	A surgeon with expertise in the management of the critically ill and postoperative patient, particularly the trauma victim, who specializes in critica…
103TM1800X	Intellectual & Developmental Disabilities Psychologist	Behavioral Health & Social Service Providers · Psychologist

Related ICD-10-CM Codes

20 rows

ICD-10-CM Code	Description
C50.919	Malignant neoplasm of unspecified site of unspecified female breast
E70.0	Classical phenylketonuria
E83.39	Other disorders of phosphorus metabolism
E88.09	Other disorders of plasma-protein metabolism, not elsewhere classified
G71.3	Mitochondrial myopathy, not elsewhere classified
H26.9	Unspecified cataract
H31.9	Unspecified disorder of choroid
H35.50	Unspecified hereditary retinal dystrophy
H35.52	Pigmentary retinal dystrophy
H35.53	Other dystrophies primarily involving the sensory retina

Showing 1–10 of 20

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 81434: Retinal Disorders Genomic Sequence Analysis Panel

Sign up for cpt 81434 policy alerts

National Reimbursement Benchmarks

CPT 81434: Retinal Disorders Genomic Sequence Analysis Panel

Sign up for cpt 81434 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What does CPT 81434 describe and where is it typically performed?

What are the typical workflow steps and who reviews the results for testing under 81434?

What reimbursement benchmarks are shown for 81434 across major commercial payers?

Which modifiers and taxonomy codes are relevant to billing or documenting services for CPT 81434?

How does 81434 relate to other CPT codes and which diagnoses are listed as related?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What does CPT 81434 describe and where is it typically performed?

What are the typical workflow steps and who reviews the results for testing under 81434?

What reimbursement benchmarks are shown for 81434 across major commercial payers?

Which modifiers and taxonomy codes are relevant to billing or documenting services for CPT 81434?

How does 81434 relate to other CPT codes and which diagnoses are listed as related?

References