CPT 81470: XLID Genomic Sequence Panel (≥60 Genes)

Commercial payers pay $943 on average nationally for this procedure.

CPT code 81470 describes a genomic sequence panel test that analyzes a patient specimen for genetic sequences across at least 60 genes, including 15 genes specifically related to X‑linked intellectual disability disorders; service type: genomic sequencing panel for XLID (molecular diagnostic testing); typical site of service: clinical laboratory or molecular diagnostics laboratory processing patient specimens such as blood or saliva.

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National Reimbursement Benchmarks

BUCA’s average commercial rate for CPT 81470 sits near $943, serving as a practical market midpoint. Blue Cross Blue Shield displays the highest mean ($1,100.10) and a wide upper tail (P90 $1,378.20), while Cigna’s mean is $896.30 with a P90 of $1,628.10, indicating a presence of high outliers. Aetna’s mean is lower at $574.90 with a very low P25 ($375.20) and a P75 around $731.20, creating a moderate interquartile spread but a lower central tendency. UnitedHealth Group’s mean is $728.70 with a P25 of $383.90 and P75 of $914.00, placing it between Aetna and BUCA on central tendency.

Assessing dispersion by interquartile range (P75 minus P25): Blue Cross Blue Shield shows a tight IQR of $249.10 ($1,078.40 - $829.90), the narrowest among payers listed, while Cigna’s IQR is $740.30 ($1,207.50 - $470.20), the widest. UnitedHealth Group’s IQR is $530.10 and Aetna’s is $355.00, placing them in the middle of the dispersion spectrum. These differences highlight that price variability across commercial payers ranges from relatively concentrated (Blue Cross Blue Shield) to highly dispersed (Cigna), with BUCA’s mean providing a useful commercial benchmark at $942.90.

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CPT 81470: XLID Genomic Sequence Panel (≥60 Genes)

Commercial payers pay $943 on average nationally for this procedure.

Customize your policy alerts

Sign up for cpt 81470 policy alerts

Get alerted when payer policies referencing 81470 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 7-year-old male with developmental delay and suspected X-linked intellectual disability (XLID) is referred by a pediatrician for comprehensive genomic testing. The patient has a family history of male relatives with intellectual disability and has undergone initial metabolic and imaging workups that were non-diagnostic. The clinician orders a targeted XLID genomic sequence panel to evaluate the patient specimen for sequence variants across at least 60 genes, including the 15 genes specified in the code descriptor. A peripheral blood sample is collected in an outpatient phlebotomy setting and sent to a Clinical Pathology/Laboratory Medicine laboratory for DNA extraction, library preparation, next-generation sequencing, bioinformatic analysis, and clinical interpretation.

The laboratory performs sequencing and variant calling, interprets variants according to clinical laboratory standards, issues a signed report with pathogenic/likely pathogenic, variants of uncertain significance, and benign findings, and provides results to the ordering Family Medicine or Internal Medicine physician and the referring genetic counselor. Typical clinical workflow steps include: specimen accessioning, test setup, sequencing run, bioinformatics pipeline, variant curation and classification, final report generation, and electronic delivery of the report to the ordering provider. Billing uses the genomic panel code for sequence analysis of the XLID gene set and may include modifier application depending on payer requirements and peculiarities of the service components.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`81471`	X‑linked intellectual disability genomic sequence analysis panel duplication/deletion	Used for detection of exon-level duplications and deletions associated with XLID; complements sequence analysis when copy-number assessment is required.
`81407`	L1CAM gene sequencing	Single-gene sequencing that may be ordered if a targeted follow-up is needed for a variant identified in the panel or when L1CAM is specifically suspected; mentioned in MolDX guidance related to XLID testing.

Related Modifiers

6 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…
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…
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…
82	Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…	- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…
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
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…
207R00000X	Internal Medicine Physician	A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
246QC1000X	Chemistry Pathology Specialist/Technologist	Technologists, Technicians & Other Technical Service Providers · Specialist/Technologist, Pathology
2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	A pediatrician who has special qualifications to manage emergencies in infants and children.
261QR0206X	Mammography Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
207QA0505X	Adult Medicine Physician	The NUCC recommends this code not be used. Choose a more appropriate code.
2278E0002X	Emergency Care Certified Respiratory Therapist	The immediate availability of diagnostic and therapeutic cardiopulmonary services in the assessment and management of trauma victims, patients requiri…

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
`81471`	X‑linked intellectual disability genomic sequence analysis panel duplication/deletion	Used for detection of exon-level duplications and deletions associated with XLID; complements sequence analysis when copy-number assessment is required.
`81407`	L1CAM gene sequencing	Single-gene sequencing that may be ordered if a targeted follow-up is needed for a variant identified in the panel or when L1CAM is specifically suspected; mentioned in MolDX guidance related to XLID testing.

Related Modifiers

6 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…
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…
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…
82	Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…	- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…
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
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…
207R00000X	Internal Medicine Physician	A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
246QC1000X	Chemistry Pathology Specialist/Technologist	Technologists, Technicians & Other Technical Service Providers · Specialist/Technologist, Pathology
2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	A pediatrician who has special qualifications to manage emergencies in infants and children.
261QR0206X	Mammography Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
207QA0505X	Adult Medicine Physician	The NUCC recommends this code not be used. Choose a more appropriate code.
2278E0002X	Emergency Care Certified Respiratory Therapist	The immediate availability of diagnostic and therapeutic cardiopulmonary services in the assessment and management of trauma victims, patients requiri…

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 81470: XLID Genomic Sequence Panel (≥60 Genes)

Sign up for cpt 81470 policy alerts

National Reimbursement Benchmarks

CPT 81470: XLID Genomic Sequence Panel (≥60 Genes)

Sign up for cpt 81470 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What clinical service is described by CPT 81470?

What steps are part of the laboratory workflow for this XLID genomic panel?

Are there other CPT codes that may be billed in relation to CPT 81470?

What diagnosis codes are relevant or commonly seen with orders for this test?

Does the page provide payer coverage and reimbursement details for CPT 81470?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What clinical service is described by CPT 81470?

What steps are part of the laboratory workflow for this XLID genomic panel?

Are there other CPT codes that may be billed in relation to CPT 81470?

What diagnosis codes are relevant or commonly seen with orders for this test?

Does the page provide payer coverage and reimbursement details for CPT 81470?

References