Summary & Overview
CPT 82104: Alpha-1-Antitrypsin Phenotype Testing
CPT code 82104 covers laboratory testing to identify the alpha–1–antitrypsin phenotype, a clinically important assay used to detect protein expression patterns that indicate alpha–1–antitrypsin deficiency. This condition is linked to increased risk for chronic obstructive pulmonary disease and liver disease, making accurate phenotype determination relevant for diagnosis, risk stratification, and management decisions at a population level. Nationally, availability and coverage of phenotype testing affect diagnostic pathways for patients with unexplained emphysema or liver dysfunction.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn how 82104 is defined clinically, where the service is typically furnished, and which payers commonly cover this laboratory testing. The publication summarizes benchmarks and reimbursement context, clarifies clinical indications tied to phenotype detection, and highlights policy updates or payer guidance that influence access to testing. Practical takeaways include expected sites of service, the clinical role of phenotype testing in alpha–1–antitrypsin deficiency evaluation, and national coverage considerations. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 82104 describes laboratory testing to determine the alpha–1–antitrypsin phenotype, a genetic protein pattern associated with moderate to severe decreases in alpha–1–antitrypsin production. Identification of this phenotype helps clinicians evaluate risk for chronic obstructive lung disease, hepatocellular disease, and hepatoma related to alpha–1–antitrypsin deficiency.
Service type: Genetic / specialized serologic laboratory testing
Typical site of service: Clinical laboratory or hospital laboratory
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient with early-onset emphysema and a family history of liver disease is referred by a pulmonologist for laboratory testing to evaluate for alpha-1-antitrypsin (A1AT) deficiency. The clinician obtains a blood specimen during an outpatient visit at a hospital outpatient laboratory or an independent clinical laboratory. The laboratory performs phenotype testing to identify A1AT variants that cause moderate to severe reductions in alpha-1-antitrypsin production, which is associated with chronic obstructive pulmonary disease, hepatocellular injury, and cirrhosis. Results are reported to the ordering provider and incorporated into the patient’s medical record; the provider uses results to guide genetic counseling, specialist referral (pulmonology or hepatology), and potential therapy decisions. The typical site of service is an outpatient clinical laboratory or hospital outpatient department; specimen collection occurs at the clinic, and analytic testing is performed in the reference laboratory.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional component of the test if the performing laboratory separates technical and professional components. |
59 |