Summary & Overview
CPT 81442: Genomic Sequence Analysis Panel for Noonan-Spectrum Disorders
CPT code 81442 represents a genomic sequence analysis panel targeting at least 12 genes linked to Noonan-spectrum disorders, which include pediatric developmental conditions with heart defects and distinctive physical features. This code is nationally significant as it supports advanced genetic testing for patients with suspected Noonan-spectrum disorders, facilitating accurate diagnosis and guiding clinical management. The procedure is classified under Pathology and Laboratory Procedures and is most commonly performed in independent laboratory settings.
Major national payers such as Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare provide coverage for this service, reflecting its clinical importance and widespread adoption. Readers will gain insight into payer coverage benchmarks, relevant policy updates, and the clinical context for the use of CPT code 81442. The publication also highlights associated modifiers, taxonomies, and ICD-10 diagnoses relevant to billing and coding, as well as related CPT codes for other genomic panels. This summary provides a comprehensive overview for stakeholders seeking to understand the billing, coverage, and clinical landscape for genomic testing in Noonan-spectrum disorders.
CPT Code Overview
CPT code 81442 is used for genomic sequence analysis panels that evaluate at least 12 genes associated with Noonan-spectrum disorders. These disorders are characterized by pediatric developmental issues, heart defects, distinctive craniofacial features, and skin and hair abnormalities. The service falls under Pathology and Laboratory Procedures, with testing typically performed at an Independent Laboratory (Place of Service 81). This code enables comprehensive genetic assessment to support clinical diagnosis and management of Noonan-spectrum conditions.
Clinical & Coding Specifications
Clinical Context
A pediatric patient presents with developmental delays, congenital heart defects, and distinctive craniofacial features. The clinical team suspects a Noonan-spectrum disorder based on physical examination and family history. The physician orders a genomic sequence analysis panel (CPT 81442) to evaluate at least 12 genes associated with Noonan-spectrum disorders. The specimen is collected and sent to an independent laboratory (Place of Service 81), where a molecular genetic pathologist interprets the results. The findings assist in confirming the diagnosis and guiding further management.
Coding Specifications
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Modifier
26: Used to indicate the professional component of the service, such as interpretation of the genomic analysis by a pathologist. -
Modifier
59: Used to identify a distinct procedural service, indicating that the genomic panel is separate from other procedures performed on the same day.
| Provider Taxonomy Code | Specialty Description |
|---|---|
207ZP0102X |