Summary & Overview
CPT 81472: CYP2C19 Genetic Testing for Drug Metabolism
CPT code 81472 represents genetic testing for the CYP2C19 gene, a critical component in determining how patients metabolize certain medications. This test identifies common genetic variants that can influence drug efficacy and safety, making it a valuable tool in personalized medicine and pharmacogenomics. Nationally, the use of CPT 81472 is expanding as healthcare providers seek to tailor treatments based on genetic information, improving outcomes and reducing adverse drug reactions.
Blue Cross Blue Shield is a key payer covering this service, reflecting broader trends in payer adoption of genetic testing for drug metabolism. Readers will gain insight into clinical benchmarks, policy updates, and the evolving role of genetic testing in medical practice. The publication also provides context on laboratory billing practices, typical sites of service, and related codes for other cytochrome P450 gene analyses. Understanding CPT 81472 is essential for stakeholders navigating the intersection of clinical genetics, laboratory operations, and payer policy.
CPT Code Overview
CPT 81472 is used to report genetic testing for the analysis of the CYP2C19 gene, which is part of the cytochrome P450 family. This test identifies common variants such as *2, *3, *4, *8, and *17 that can impact drug metabolism. The service type is genetic testing, and it is typically performed in a laboratory setting (Place of Service 81). This code is essential for guiding medication management and optimizing therapeutic outcomes based on individual genetic profiles.
Clinical & Coding Specifications
Clinical Context
A patient is referred for genetic testing to evaluate their CYP2C19 gene variants, which influence drug metabolism. This is commonly performed in a laboratory setting (POS 81) when a provider needs to determine how a patient may respond to certain medications, such as antiplatelet drugs used in cardiovascular disease. The workflow typically involves a physician ordering the test, a laboratory collecting and analyzing the sample, and a medical geneticist or molecular pathologist interpreting the results. The findings may guide medication selection or dosing, especially in patients with a history of atherosclerotic heart disease or acute myocardial infarction.
Coding Specifications
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Modifiers:
26: Professional Component – Used when only the interpretation of the genetic test is performed by a physician or specialist.TC: Technical Component – Used when only the laboratory performs the technical aspects of the test, such as sample processing and analysis.
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Provider Taxonomies:
Taxonomy Code Specialty Name