CPT 81435: Hereditary Colon Cancer Gene Panel, Sequence + CNV

Commercial payers pay $797 on average nationally for this procedure.

CPT code 81435 describes a genomic sequence analysis panel for hereditary colon cancer–related disorders that evaluates a patient specimen for sequence variants and copy number variants across at least five genes; this molecular diagnostic service is typically performed by a laboratory or molecular pathology service and is billed for genetic testing of germline DNA, usually with specimen collection and analysis occurring in a clinical laboratory or hospital pathology setting.

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National Reimbursement Benchmarks

National commercial rates for CPT 81435 cluster around BUCA’s average commercial benchmark of $797.10, with substantial variation across individual carriers. Blue Cross Blue Shield shows the highest dispersion between its 25th and 75th percentiles (P75–P25 = $485.70), reflecting broader contractual variability, while Aetna and UnitedHealth Group display tighter mid‑range spreads (Aetna range = $227.70; UnitedHealth Group range = $240.20), indicating more consistency in negotiated commercial rates. Cigna’s interquartile spread ($877.80) is also wide, and BUCA’s own interquartile span ($391.00) sits between the narrowest and widest payers.

Mean rates further illustrate divergence: Blue Cross Blue Shield and Cigna have higher mean levels ($942.30 and $860.10, respectively) above BUCA’s average, while UnitedHealth Group and Aetna have lower means ($530.10 and $420.10). Payer-specific tails (P90) extend substantially for Blue Cross Blue Shield and Cigna, contributing to top-end variability in the commercial market for this code.

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CPT 81435: Hereditary Colon Cancer Gene Panel, Sequence + CNV

Commercial payers pay $797 on average nationally for this procedure.

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Sign up for cpt 81435 policy alerts

Get alerted when payer policies referencing 81435 are released or updated.

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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 42-year-old patient with a strong family history of colorectal cancer (Z80.0) and a personal history of a colon neoplasm (Z85.038) is referred to a clinical genetics or molecular pathology service for hereditary colorectal cancer evaluation. The clinician orders a multigene genomic sequencing panel targeting at least five genes associated with hereditary colon cancer syndromes to detect sequence variants and copy number variants. The specimen is typically peripheral blood (EDTA) or saliva collected in an outpatient clinic, genetics office, or hospital outpatient laboratory. The sample is processed in a molecular diagnostics laboratory where a laboratory analyst performs next-generation sequencing (NGS) bioinformatic analysis, variant calling, and copy-number interrogation per validated laboratory protocols. A genetics professional (Medical Geneticist or Molecular Genetic Pathologist) reviews the analytic findings, classifies variants according to current standards, and issues a report to the ordering clinician. Typical sites of service include outpatient genetics clinics, hospital-based molecular laboratories, and independent reference laboratories. The clinical workflow includes pre-test counseling (often by a genetics professional or family medicine physician), specimen collection, laboratory sequencing and bioinformatics (81435 service), post-test interpretation, and communication of results to the patient and referring provider.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`81292`	MLH1 gene analysis	Single-gene analysis for `MLH1`; may be performed when a specific pathogenic variant or focused testing is indicated instead of a panel.
`81295`	MSH2 gene analysis	Single-gene analysis for `MSH2`; used when targeted sequencing of a mismatch repair gene is clinically warranted.
`81298`	MSH6 gene analysis	Single-gene analysis for `MSH6`; an alternative to panel testing for isolated gene evaluation.
`81301`	PTEN gene analysis	Single-gene analysis for `PTEN`; relevant when clinical features suggest PTEN-related syndromes impacting colorectal neoplasia risk.
`81436`	Hereditary colon cancer disorders, duplication/deletion analysis panel	Complementary service focusing on duplication/deletion (copy-number) analysis for hereditary colon cancer genes; often billed when large rearrangement testing is required in addition to sequencing.

Related Modifiers

7 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…
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…
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…
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…
22	Modifier –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…
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…

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.
207ZP0213X	Pediatric Pathology Physician	A pediatric pathologist is expert in the laboratory diagnosis of diseases that occur during fetal growth, infancy and child development. The practice …
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
246ZC0007X	Surgical Assistant	A surgical assistant is a skilled practitioner who has undergone formalized education and training as a surgical assistant. The surgical assistant per…
261QX0203X	Radiation Oncology Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
208C00000X	Colon & Rectal Surgery Physician	A colon and rectal surgeon is trained to diagnose and treat various diseases of the intestinal tract, colon, rectum, anal canal and perianal area by m…
207YS0123X	Facial Plastic Surgery Physician	An otolaryngologist who specializes in facial plastic surgery.
364S00000X	Clinical Nurse Specialist	A registered nurse who, through a graduate degree program in nursing, or through a formal post-basic education program or continuing education courses…

Related ICD-10-CM Codes

26 rows

ICD-10-CM Code	Description
C18.4	Malignant neoplasm of transverse colon
C18.9	Malignant neoplasm of colon, unspecified
C19	Malignant neoplasm of rectosigmoid junction
C20	Malignant neoplasm of rectum
D12.6	Benign neoplasm of colon, unspecified
D12.7	Benign neoplasm of rectosigmoid junction
D12.8	Benign neoplasm of rectum
K55.9	Vascular disorder of intestine, unspecified
K57.30	Diverticulosis of large intestine without perforation or abscess without bleeding
K57.32	Diverticulitis of large intestine without perforation or abscess without bleeding

Showing 1–10 of 26

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
`81292`	MLH1 gene analysis	Single-gene analysis for `MLH1`; may be performed when a specific pathogenic variant or focused testing is indicated instead of a panel.
`81295`	MSH2 gene analysis	Single-gene analysis for `MSH2`; used when targeted sequencing of a mismatch repair gene is clinically warranted.
`81298`	MSH6 gene analysis	Single-gene analysis for `MSH6`; an alternative to panel testing for isolated gene evaluation.
`81301`	PTEN gene analysis	Single-gene analysis for `PTEN`; relevant when clinical features suggest PTEN-related syndromes impacting colorectal neoplasia risk.
`81436`	Hereditary colon cancer disorders, duplication/deletion analysis panel	Complementary service focusing on duplication/deletion (copy-number) analysis for hereditary colon cancer genes; often billed when large rearrangement testing is required in addition to sequencing.

Related Modifiers

7 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…
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…
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…
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…
22	Modifier –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…
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…

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.
207ZP0213X	Pediatric Pathology Physician	A pediatric pathologist is expert in the laboratory diagnosis of diseases that occur during fetal growth, infancy and child development. The practice …
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
246ZC0007X	Surgical Assistant	A surgical assistant is a skilled practitioner who has undergone formalized education and training as a surgical assistant. The surgical assistant per…
261QX0203X	Radiation Oncology Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
208C00000X	Colon & Rectal Surgery Physician	A colon and rectal surgeon is trained to diagnose and treat various diseases of the intestinal tract, colon, rectum, anal canal and perianal area by m…
207YS0123X	Facial Plastic Surgery Physician	An otolaryngologist who specializes in facial plastic surgery.
364S00000X	Clinical Nurse Specialist	A registered nurse who, through a graduate degree program in nursing, or through a formal post-basic education program or continuing education courses…

Related ICD-10-CM Codes

26 rows

ICD-10-CM Code	Description
C18.4	Malignant neoplasm of transverse colon
C18.9	Malignant neoplasm of colon, unspecified
C19	Malignant neoplasm of rectosigmoid junction
C20	Malignant neoplasm of rectum
D12.6	Benign neoplasm of colon, unspecified
D12.7	Benign neoplasm of rectosigmoid junction
D12.8	Benign neoplasm of rectum
K55.9	Vascular disorder of intestine, unspecified
K57.30	Diverticulosis of large intestine without perforation or abscess without bleeding
K57.32	Diverticulitis of large intestine without perforation or abscess without bleeding

Showing 1–10 of 26

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 81435: Hereditary Colon Cancer Gene Panel, Sequence + CNV

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National Reimbursement Benchmarks

CPT 81435: Hereditary Colon Cancer Gene Panel, Sequence + CNV

Sign up for cpt 81435 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 81435 represent and where is this service typically performed?

Which billing modifiers are commonly used with CPT 81435 and when are they applied?

How do commercial reimbursement rates vary across payers for CPT 81435?

What clinical scenarios or ICD-10 codes commonly support use of the hereditary colon cancer panel (81435)?

Are there related CPT codes or tests that are billed instead of or alongside 81435?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What does CPT 81435 represent and where is this service typically performed?

Which billing modifiers are commonly used with CPT 81435 and when are they applied?

How do commercial reimbursement rates vary across payers for CPT 81435?

What clinical scenarios or ICD-10 codes commonly support use of the hereditary colon cancer panel (81435)?

Are there related CPT codes or tests that are billed instead of or alongside 81435?

References