Summary & Overview
CPT 81471: Genomic Sequencing for X-Linked Intellectual Disability
CPT code 81471 represents a comprehensive genomic sequencing procedure for X-linked intellectual disability (XLID), encompassing both syndromic and non-syndromic presentations. This test involves duplication and deletion analysis across a panel of at least 60 genes, including key genes such as ARX, ATRX, CDKL5, FGD1, FMR1, and others. The procedure is classified under Genomic Sequencing Procedures and Other Molecular Multianalyte Assays and is most commonly performed in an office setting.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, are covered in this analysis. Readers will gain insight into payer coverage policies, relevant clinical indications, and billing considerations for CPT 81471. The publication also provides context on associated ICD-10 diagnoses, common modifiers used in Medicare billing, and related CPT codes for comparison. Benchmarks and policy updates are included to inform stakeholders about current trends in coverage and utilization.
This summary offers a clear overview of the clinical and billing landscape for CPT 81471, highlighting its importance in the diagnosis and management of XLID. The information is designed to support healthcare professionals, billing specialists, and policy analysts in understanding the scope and implications of this genomic testing procedure.
CPT Code Overview
CPT 81471 is used for genomic sequencing procedures targeting X-linked intellectual disability (XLID), including both syndromic and non-syndromic forms. This code covers duplication and deletion gene analysis and requires the examination of at least 60 genes, such as ARX, ATRX, CDKL5, FGD1, FMR1, HUWE1, IL1RAPL, KDM5C, L1CAM, MECP2, MED12, MID1, OCRL, RPS6KA3, and SLC16A2. The service type is Genomic Sequencing Procedures and Other Molecular Multianalyte Assays, typically performed in an office setting (POS 11).
Clinical & Coding Specifications
Clinical Context
A male pediatric patient presents to a genetics clinic with developmental delays, intellectual disability, and a family history suggestive of X-linked inheritance. The clinical workflow involves a medical geneticist evaluating the patient, obtaining a detailed family history, and recommending genomic sequencing to identify potential duplications or deletions in genes associated with X-linked intellectual disability. The procedure is performed in an office setting (Place of Service 11), and the results are used to guide further management, genetic counseling, and risk assessment for family members.
Coding Specifications
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Modifiers:
GX: Used when a provider attests that a service is statutorily excluded or does not meet the definition of any Medicare benefit.GY: Used when a service is statutorily excluded from Medicare coverage or is not a Medicare benefit.
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207SG0201X |