Summary & Overview
CPT 81410: Genomic Sequencing for Heritable Thoracic Aortic Disease
CPT code 81410 is a genomic sequencing procedure targeting heritable thoracic aortic diseases, including Marfan syndrome, Loeys-Dietz syndrome, Ehlers-Danlos syndrome type IV, and arterial tortuosity syndrome. This code is significant nationally as it enables precise molecular diagnosis for patients with suspected genetic aortic disorders, facilitating early intervention and tailored management. The procedure is typically performed in laboratory settings, either independent or hospital-based, and is recognized by major payers such as Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.
This publication provides a comprehensive overview of 81410, including payer coverage, clinical context, and policy updates. Readers will gain insight into current benchmarks for genomic sequencing in thoracic aortic disease, understand payer-specific considerations, and review the latest developments in molecular pathology billing. The article also highlights the importance of accurate coding and documentation for laboratory services, ensuring compliance with payer requirements. By examining the role of 81410 in the broader landscape of genetic testing, the publication offers valuable information for stakeholders navigating the evolving field of precision medicine.
CPT Code Overview
CPT code 81410 represents a genomic sequencing procedure for heritable thoracic aortic disease. This includes conditions such as Marfan syndrome, Loeys-Dietz syndrome, Ehlers-Danlos syndrome type IV, and arterial tortuosity syndrome. The service type is genomic sequencing and molecular pathology, typically performed in a laboratory setting, such as an independent laboratory or hospital lab (commonly place of service codes 81 or 19). This procedure is used to identify genetic variants associated with thoracic aortic disease, supporting clinical diagnosis and management.
Clinical & Coding Specifications
Clinical Context
A patient presents with clinical features suggestive of a heritable thoracic aortic disease, such as Marfan syndrome, Loeys-Dietz syndrome, Ehlers-Danlos syndrome type IV, or arterial tortuosity syndrome. The provider, often a family medicine or internal medicine physician, refers the patient for genomic sequencing to confirm the diagnosis and guide management. The procedure is performed in a laboratory setting, such as an independent laboratory or hospital lab (typically Place of Service 81 or 19). The workflow involves specimen collection, laboratory analysis, and interpretation of results by a qualified professional.
Coding Specifications
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Modifiers:
- Modifier
26: Used to indicate the professional component of the service, such as interpretation of the genomic sequencing results. - Modifier
TC: Used to indicate the technical component, which includes the laboratory processing and sequencing.
- Modifier
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
291U00000X | Clinical Medical Laboratory |
207Q00000X | Family Medicine Physician |
207R00000X | Internal Medicine Physician |
These taxonomies represent the laboratory performing the test and the physicians who may order or interpret the results.
Related Diagnoses
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E72.10: Disorders of amino-acid transport and metabolism, unspecified- Relevant for patients with suspected metabolic disorders that may be identified through genomic sequencing.
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E72.11: Hyperammonemia- Indicates elevated ammonia levels, which can be associated with certain genetic metabolic conditions.
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E72.20: Disorders of urea cycle metabolism, unspecified- Pertinent for patients with suspected urea cycle disorders, which may be evaluated by genomic sequencing.
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E72.30: Disorders of sulfur-bearing amino-acid metabolism, unspecified- Used for patients with possible sulfur amino acid metabolism disorders, potentially identified through genetic testing.
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E72.40: Disorders of branched-chain amino-acid metabolism, unspecified- Relevant for patients with suspected branched-chain amino acid metabolism disorders, which may be detected by genomic sequencing.
Related CPT Codes
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81411: Genomic sequencing procedure; heritable thoracic aortic disease, additional (e.g., targeted panel)- Used for additional or targeted sequencing panels related to heritable thoracic aortic disease. This code may be used in conjunction with
81410when further genetic analysis is required.
- Used for additional or targeted sequencing panels related to heritable thoracic aortic disease. This code may be used in conjunction with
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81479: Unlisted molecular pathology procedure- Used for molecular pathology procedures that do not have a specific CPT code. This code may be used as an alternative when the genomic sequencing performed does not fit the description of
81410or81411.
- Used for molecular pathology procedures that do not have a specific CPT code. This code may be used as an alternative when the genomic sequencing performed does not fit the description of
National Reimbursement Benchmarks
For CPT code 81410, the national mean rate for BUCA (average commercial) is $398.00, which is notably higher than typical Medicare rates, though Medicare data is not available in the input for this code. Among individual commercial payers, Blue Cross Blue Shield has the highest mean rate at $442.18, while Aetna is the lowest at $368.43.
Rate dispersion varies significantly across payers. Cigna shows the widest spread, with a difference of $430.50 between its 75th and 25th percentiles, indicating substantial variability in contracted rates. In contrast, Aetna has the tightest range at $161.00, suggesting more consistent reimbursement levels. The table and chart below present the full breakdown of national benchmarks for each payer.
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.