Summary & Overview
CPT 81475: Cytogenomic Microarray Analysis for Chromosomal Abnormalities
CPT code 81475 represents cytogenomic constitutional (genome-wide) microarray analysis, a critical genetic testing procedure used to detect copy number variants and constitutional chromosomal abnormalities. This code is widely recognized in clinical genetics for its role in diagnosing conditions such as Down syndrome, Edwards syndrome, and other chromosomal abnormalities. The procedure is typically performed in laboratory settings and is essential for providing detailed genomic information that informs patient care and clinical decision-making.
Blue Cross Blue Shield is a key payer covering this service, reflecting its importance in both commercial and public health insurance programs. Readers will gain insights into the clinical context of 81475, including its relevance for genetic diagnostics, common billing practices such as the use of modifier codes 26 and TC, and associated provider taxonomies. The publication also highlights related CPT codes and ICD-10 diagnoses, offering a comprehensive overview of how this procedure fits into broader genetic testing and pathology workflows. Policy updates and reimbursement benchmarks are discussed to provide a clear understanding of current trends and payer coverage for this essential genetic analysis.
CPT Code Overview
CPT code 81475 is used for cytogenomic constitutional (genome-wide) microarray analysis, specifically for the interrogation of genomic regions to identify copy number variants such as constitutional chromosomal abnormalities. This procedure falls under the category of genetic testing and is typically performed in a laboratory setting (Place of Service 81). The test plays a crucial role in diagnosing and understanding genetic conditions by providing comprehensive genomic information.
Clinical & Coding Specifications
Clinical Context
A child presents to a genetics clinic with developmental delays and dysmorphic features. The clinical team suspects a chromosomal abnormality and orders cytogenomic constitutional (genome-wide) microarray analysis using CPT code 81475. The workflow involves collecting a blood sample, which is sent to a laboratory (Place of Service 81) for analysis. A clinical geneticist or molecular genetic pathologist interprets the results to identify copy number variants that may explain the patient's symptoms. The findings are then discussed with the family and used to guide further management.
Coding Specifications
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Modifiers:
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26: Used when reporting only the professional component (interpretation of the test results). - Modifier
TC: Used when reporting only the technical component (performance of the laboratory test).
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Provider Taxonomies:
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