Summary & Overview
CPT 81432: Hereditary Breast Cancer Multi-Gene Sequencing Panel
CPT code 81432 represents a genomic sequencing panel that evaluates a patient specimen for genetic alterations in at least five genes associated with hereditary breast cancer disorders, including both sequence variants and copy number variants. Nationally, this code captures multi-gene molecular testing used in hereditary cancer assessment and has implications for diagnostic workflows, care pathways, and laboratory reporting standards.
Major national payers included in coverage analyses are Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. The publication summarizes coverage trends and payer approaches to multi-gene hereditary breast cancer testing and situates CPT code 81432 within the broader set of molecular testing codes used for hereditary cancer evaluation.
Readers will learn the clinical scope of the service represented by CPT code 81432, typical laboratory and diagnostic contexts where the test is performed, and how this code relates to other molecular pathology codes used for BRCA and hereditary cancer testing. The report also provides benchmark considerations, policy and coding updates relevant to molecular diagnostic services, and a concise mapping to related molecular testing codes for clinical and billing reference.
Billing Code Overview
CPT code 81432 describes a genomic sequence analysis panel performed by a laboratory analyst to evaluate a patient specimen for genetic sequences of at least five genes associated with hereditary breast cancer-related disorders. The analysis includes interrogation for both sequence variants and copy number variants, providing comprehensive molecular evaluation for inherited breast cancer risk.
Service type: Genomic sequence analysis panel for hereditary cancer genes
Typical site of service: Clinical molecular diagnostics laboratory
Clinical & Coding Specifications
Clinical Context
A 42-year-old woman with a family history of breast cancer (mother diagnosed at age 45) presents to a genetics clinic after discussion with her primary care physician. She has no prior genetic testing. The clinician documents a personal concern for hereditary breast and ovarian cancer syndrome and orders a multi-gene hereditary breast cancer panel to evaluate germline sequence variants and copy number variants across at least five genes associated with hereditary breast cancer, including but not limited to BRCA1 and BRCA2. A blood specimen is collected in the outpatient clinic, labeled, and sent to a certified molecular genetics laboratory. The laboratory performs comprehensive genomic sequence analysis, including targeted next-generation sequencing and bioinformatic analysis to detect sequence variants and copy number changes. Results are reviewed by a clinical molecular geneticist and reported to the ordering provider with variant interpretation and clinical significance. Typical sites of service include an outpatient genetics clinic, hospital outpatient laboratory draw station, or an independent reference laboratory. Typical patient scenario: adult patient with family history indicative of increased hereditary breast cancer risk (ICD-10 C56.3 noted when applicable for concurrent ovarian involvement or suspicion), ordered by a geneticist or oncology team for diagnostic and risk-stratification purposes.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional Component | Use when billing only the professional component (interpretation) of the molecular test separate from technical processing. |
TC | Technical Component | Use when billing only the technical component (laboratory processing) of the test. |
59 | Distinct Procedural Service | Use to indicate a separately identifiable service when another service on the same day is distinct and not part of the molecular panel. |
90 | Reference (Outside) Laboratory | Use when the service was performed by an outside laboratory and billing requires identification of that arrangement. |
62 | Two Surgeons | Rare for this service; used if two qualified professionals share responsibility for interpretation in a collaborative setting. |
80 | Assistant Surgeon | Uncommon; apply only if an assisting provider with relevant billing submits a portion of the service. |
22 | Increased Procedural Services | Use when work or complexity substantially exceeds typical expectations and documentation supports increased complexity for interpretation or analysis. |
52 | Reduced Services | Use when the service was partially reduced or not completed as originally planned (limited panel run). |
53 | Discontinued Procedure | Use when testing was started but discontinued due to specimen quality or other documented issue. |
59 | Distinct Procedural Service | Use when a separate, distinct molecular test is billed the same day and requires differentiation (duplicate of row retained for emphasis). |
90 | Reference (Outside) Laboratory | Use to indicate performance by an external reference lab (duplicate retained for emphasis). |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207SG0201X | Medical Genetics, Ph.D. Medical Genetics | Laboratory directors and Ph.D. clinical laboratory geneticists performing or overseeing molecular testing. |
207SC0300X | Medical Genetics, Clinical Genetics (M.D.) | Clinical geneticists who order and interpret hereditary cancer testing for patient management. |
207SG0205X | Medical Genetics, Clinical Molecular Genetics | Specialists in molecular test development, validation, and interpretation for hereditary cancer panels. |
207SG0203X | Medical Genetics, Clinical Cytogenetics | Cytogeneticists consulted when copy number variant confirmation or cytogenomic correlation is required. |
207SG0202X | Medical Genetics, Clinical Biochemical Genetics | Clinical biochemical geneticists may be involved when metabolic or biochemical phenotypes overlap with genetic findings. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C56.3 | Data not provided in the input | The input listed C56.3 without a description; when used in context it typically indicates involvement of the ovary which can be clinically relevant in evaluating hereditary breast and ovarian cancer syndromes. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
81433 | Hereditary breast cancer-related disorders, duplication/deletion analysis | Used to report targeted duplication/deletion (copy number) testing that may complement or be billed alongside sequence analysis when separate methodology is used. |
81211 | BRCA1, BRCA2 gene analysis, full sequence analysis | Specific full-sequence testing for BRCA1/BRCA2; may be ordered instead of or in addition to a multi-gene panel when focused single-gene analysis is indicated. |
81212 | BRCA1, BRCA2 gene analysis, known familial variants | Reports testing for known familial BRCA variants when a pathogenic variant has been previously identified in the family; often a follow-up targeted test rather than a full panel. |
81213 | BRCA1, BRCA2 gene analysis, duplication/deletion variants | Reports BRCA-specific duplication/deletion analysis; used when copy number testing focused on BRCA genes is performed as part of the workup. |
81479 | Unlisted molecular pathology procedure | Used when the performed molecular test does not match established codes and an unlisted code with supporting documentation and rationale is required. |