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    v1.0.31
    OpenPayerBilling CodesGenomic Sequencing Procedures and Other Molecular Multianalyte AssaysCPT cpt-81435-hereditary-colon-cancer-multi-gene-sequencing
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    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.

    For related coverage guidance, see recent payer policy updates: Minimal Residual Disease (MRD) Testing for Cancer, Biomarker Testing Mandate, Prenatal (Fetal) Diagnostic Testing.

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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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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    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 CodeDescriptionRelationship to This Procedure

    Related Modifiers

    7 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…
    90Modifier ‑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…
    59Modifier 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…
    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…
    80CPT® 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…
    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…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207SG0201X
    207ZP0213X
    207Q00000X
    246ZC0007X
    261QX0203X
    208C00000X
    207YS0123X
    364S00000X

    Related ICD-10-CM Codes

    26 rows

    ICD-10-CM CodeDescription
    C18.4Malignant neoplasm of transverse colon
    C18.9Malignant neoplasm of colon, unspecified
    C19Malignant neoplasm of rectosigmoid junction
    C20Malignant neoplasm of rectum
    D12.6Benign neoplasm of colon, unspecified
    D12.7Benign neoplasm of rectosigmoid junction
    D12.8Benign neoplasm of rectum
    K55.9Vascular disorder of intestine, unspecified
    K57.30Diverticulosis of large intestine without perforation or abscess without bleeding
    K57.32Diverticulitis of large intestine without perforation or abscess without bleeding

    Showing 1–10 of 26

    Related Payer Policy Updates

    Specialty: Genetic & Molecular Testing1 / 3

    10 rows

    PolicyPayerEffective Date
    Minimal Residual Disease (MRD) Testing for Cancerregence2027-01-01
    Biomarker Testing MandateBlue Cross Blue Shield - Rhode Island2027-01-01
    Prenatal (Fetal) Diagnostic TestingBlue Cross Blue Shield - Rhode Island2027-01-01
    Oral Cancer Screening and TestingOscar Health2027-01-01
    RTM Testing for Alpha-1 Antitrypsin DeficiencyOscar Health2027-01-01
    Cytochrome P450 Genotype-Guided Treatment Strategy Corporate Medical Policybcbsvermont2027-01-01
    Polygenic Risk ScoreBlue Cross Blue Shield - Rhode Island2026-12-01
    Gene Expression Profiling for Cutaneous MelanomaBlue Cross Blue Shield - Rhode Island2026-12-01
    Genetic Testing for Macular Degenerationregence2026-11-01
    Pharmacogenetic Panel Testing (for Ohio Only)Colorado Rocky Mountain Health Plans2026-11-01

    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. 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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    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.

    81292MLH1 gene analysisSingle-gene analysis for MLH1; may be performed when a specific pathogenic variant or focused testing is indicated instead of a panel.
    81295MSH2 gene analysisSingle-gene analysis for MSH2; used when targeted sequencing of a mismatch repair gene is clinically warranted.
    81298MSH6 gene analysisSingle-gene analysis for MSH6; an alternative to panel testing for isolated gene evaluation.
    81301PTEN gene analysisSingle-gene analysis for PTEN; relevant when clinical features suggest PTEN-related syndromes impacting colorectal neoplasia risk.
    81436Hereditary colon cancer disorders, duplication/deletion analysis panelComplementary 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.