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    v1.0.30
    OpenPayerBilling CodesGenomic Sequencing Procedures and Other Molecular Multianalyte AssaysCPT cpt-81432-hereditary-breast-cancer-gene-panel-sequence-and-cnv
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    CPT 81432: Hereditary Breast Cancer Multigene Panel (≥5 Genes)

    Commercial payers pay $907 on average nationally for this procedure.

    CPT code 81432 describes a genomic sequence analysis panel performed by a laboratory analyst to evaluate a patient specimen for sequence variants and copy number variants across at least five genes associated with hereditary breast cancer disorders; this molecular pathology service is typically performed in a clinical molecular genetics laboratory and is provided as a genetic testing service for hereditary cancer risk assessment rather than a point-of-care procedure.

    For related coverage guidance, see recent payer policy updates: Biomarker Testing Mandate, Prenatal (Fetal) Diagnostic Testing, Oral Cancer Screening and Testing.

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    National Reimbursement Benchmarks

    Commercial reimbursement for CPT 81432 centers around BUCA’s average commercial rate of $907.30, with notable variation among major payers. Blue Cross Blue Shield (BCBS) and Cigna show higher central tendencies ($1,131.70 mean for BCBS; $946.10 mean for Cigna) and wider upper tails, while Aetna and UnitedHealth Group present lower medians ($543 and $407.40, respectively) that pull their overall distributions downward compared with BUCA’s midpoint of $805.30.

    Dispersion measured by the interquartile range (P75–P25) highlights differences in pricing consistency: Blue Cross Blue Shield’s IQR is $595.00, Cigna’s IQR is $1,193.10, BUCA’s IQR is $562.00, Aetna’s IQR is $371.00, and UnitedHealth Group’s IQR is $380.50. Cigna displays the widest spread, indicating the most variability in commercial rates, while Aetna has the tightest IQR, suggesting relatively more consistent negotiated rates.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    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.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    81433

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    90Modifier ‑90 (Reference/Outside Laboratory) indicates that a laboratory test was performed by an entity other than the treating or reporting provider. The American Medical Association defines…- Use CPT modifier -90 when a laboratory test is performed by an outside/reference laboratory (an entity other than the treating or reporting physician or qualified professional) and the claim needs…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207SG0201X
    207SC0300X
    207SG0205X
    207SG0203X
    207SG0202X
    2865C1500X
    261QF0050X
    225600000X

    Related Payer Policy Updates

    Specialty: Genetic & Molecular Testing1 / 3

    10 rows

    PolicyPayerEffective Date
    Biomarker Testing MandateBlue Cross Blue Shield - Rhode Island2027-01-01
    Prenatal (Fetal) Diagnostic TestingBlue Cross Blue Shield - Rhode Island2027-01-01
    Oral Cancer Screening and TestingOscar Health2027-01-01
    RTM Testing for Alpha-1 Antitrypsin DeficiencyOscar Health2027-01-01
    Cytochrome P450 Genotype-Guided Treatment Strategy Corporate Medical Policybcbsvermont2027-01-01
    Polygenic Risk ScoreBlue Cross Blue Shield - Rhode Island2026-12-01
    Gene Expression Profiling for Cutaneous MelanomaBlue Cross Blue Shield - Rhode Island2026-12-01
    Pharmacogenetic Panel Testing (for Ohio Only)Colorado Rocky Mountain Health Plans2026-11-01
    Genetic Testing for Neurological Disorders (for Kentucky Only)Colorado Rocky Mountain Health Plans2026-11-01
    Cell-Free Fetal DNA Testing (for Kansas Only)Colorado Rocky Mountain Health Plans2026-11-01

    Related Codes

    CPT-81410-GENOMIC-PANEL-AORTIC-DISEASE

    CPT 81410: Heritable Thoracic Aortic Disease Targeted Gene Panel

    CPT-81411-GENETIC-DUPLICATION-DELETION-PANEL-AORTIC-DISEASE

    CPT 81411: Genetic Panel for Aortic Dysfunction Copy Number Analysis

    CPT-81412-ASHKENAZI-JEWISH-GENOMIC-SEQUENCE-PANEL

    CPT 81412: Ashkenazi Jewish–Associated Genetic Sequence Panel

    CPT-81413-GENOMIC-PANEL-CARDIAC-ION-CHANNELOPATHIES

    CPT 81413: Cardiac Ion Channelopathy Targeted Gene Panel

    CPT-81414-CARDIAC-ION-CHANNELOPATHY-CNV-PANEL

    CPT 81414: Cardiac Ion Channelopathy Copy Number Variant Panel

    CPT-81415-EXOME-SEQUENCE-ANALYSIS-UNEXPLAINED-DISORDER

    CPT 81415: Exome Sequence Analysis for Unexplained Disorder

    CPT-81416-FAMILIAL-EXOME-SEQUENCE-ANALYSIS

    CPT 81416: Relative Exome Sequence Analysis for Reference Exome

    CPT-81417-EXOME-SEQUENCE-REEVALUATION

    CPT 81417: Exome Reanalysis for New Clinical Information

    CPT-81418-PHARMACOGENOMIC-MULTIGENE-DRUG-METABOLISM-PANEL

    CPT 81418: Pharmacogenetic Multigene Panel Including CYP2C19 and CYP2D6

    CPT-81419-GENOMIC-SEQUENCE-PANEL-EPILEPSY

    CPT 81419: Genomic Sequence Analysis Panel for Epilepsy

    Showing 1–10 of 43

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    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.
    81211BRCA1, BRCA2 gene analysis, full sequence analysisSpecific 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.
    81212BRCA1, BRCA2 gene analysis, known familial variantsReports 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.
    81213BRCA1, BRCA2 gene analysis, duplication/deletion variantsReports BRCA-specific duplication/deletion analysis; used when copy number testing focused on BRCA genes is performed as part of the workup.
    81479Unlisted molecular pathology procedureUsed when the performed molecular test does not match established codes and an unlisted code with supporting documentation and rationale is required.