Summary & Overview
CPT 81411: Apolipoprotein E (ApoE) Gene Analysis
CPT 81411 covers Apolipoprotein E (ApoE) gene analysis for common variants (for example, *E2, *E3, E4). This molecular genetic test identifies APOE genotypes used in clinical risk assessment and research contexts, and it is commonly performed in laboratory settings. Nationally, APOE testing is notable for its role in evaluating genetic susceptibility in neurodegenerative and vascular conditions, influencing diagnostic evaluation and clinical decision-making in some specialty settings.
Major commercial payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. The publication summarizes coverage considerations and coding context for payers widely used across the United States. Readers will find a concise overview of the clinical purpose of the code, typical billing context, commonly associated claim modifiers, relevant specialty taxonomies, and a list of supporting ICD-10 diagnoses tied to vascular and connective tissue conditions that may prompt testing. The report also situates CPT 81411 alongside related molecular pathology codes to clarify coding hierarchies and laboratory service lines.
This summary is designed to inform billing, coding, and policy teams about the clinical and administrative context of CPT 81411, outline the payer landscape, and provide reference points for related molecular pathology procedures and diagnostic indications. Data not available in the input is noted where applicable.
CPT Code Overview
CPT 81411 is a genetic test for Apolipoprotein E (ApoE) gene analysis, identifying common variants such as *E2, *E3, and *E4. This assay evaluates APOE genotype variants that have clinical relevance in risk assessment and genetic characterization.
Service Type: Genetic Testing
Typical Site of Service: Laboratory (POS 81)
Clinical & Coding Specifications
Clinical Context
A middle-aged patient with a family history of early-onset cardiovascular disease and known aortic pathology presents for genetic evaluation. The patient has a documented aortic aneurysm or dissection or a syndromic connective tissue disorder (e.g., Marfan syndrome or vascular Ehlers-Danlos) and the clinical team orders Apolipoprotein E (ApoE) gene analysis to assess common APOE alleles (*E2, *E3, *E4) that may inform risk stratification for cardiovascular and lipid-related considerations. The typical workflow: test is ordered by a cardiologist, medical geneticist, or clinical genetic counselor; specimen (blood or saliva) is collected and sent to the laboratory (POS 81); the laboratory performs genotyping; a result report is generated and delivered to the ordering clinician; the professional component may involve interpretation by a board-certified clinical geneticist or molecular pathologist and documented in the medical record.
Coding Specifications
Modifier 26 - Professional Component
- Use when billing only the professional interpretation component of the genetic test performed by a qualified physician or other allowed professional.
Modifier 59 - Distinct Procedural Service
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Use when the ApoE gene analysis is a distinct service separate from other procedures performed on the same day for the same patient; applies when documentation supports separate and independent services.
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Provider Taxonomies:
| Taxonomy Code | Specialty |
|---|---|
207SG0201X | Medical Genetics, Ph.D. Medical Genetics |
207SG0202X | Medical Genetics, Clinical Genetics (M.D.) |
207SG0203X | Medical Genetics, Clinical Biochemical Genetics |
207SG0205X | Medical Genetics, Molecular Genetics |
Related Diagnoses
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I71.010— Dissection of ascending aorta- Clinical relevance: Patients with aortic dissection may undergo genetic evaluation for inherited risk factors associated with aortic disease; ApoE genotyping can be part of cardiovascular risk assessment.
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I71.011— Dissection of aortic arch- Clinical relevance: Similar relevance to other aortic dissections; genetic testing may contribute to overall risk profiling.
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I71.11— Aneurysm of the ascending aorta, ruptured- Clinical relevance: Aortic aneurysm pathology may prompt genetic testing to identify inherited contributors to vessel wall integrity and cardiovascular risk modifiers.
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I71.12— Aneurysm of the aortic arch, ruptured- Clinical relevance: Ruptured aneurysm history can trigger genetic evaluation for syndromic or inherited conditions impacting vascular structure and lipid-related risk.
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I71.21— Aneurysm of the ascending aorta, without rupture- Clinical relevance: Non-ruptured aneurysm monitoring may include genetic testing to inform family screening and risk assessment.
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I71.22— Aneurysm of the aortic arch, without rupture- Clinical relevance: Same clinical rationale as other aortic aneurysm diagnoses for consideration of genetic evaluation.
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Q25.43— Congenital aneurysm of aorta- Clinical relevance: Congenital aortic aneurysm suggests potential genetic etiologies; genotyping may be part of diagnostic workup.
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Q25.44— Congenital dilation of aorta- Clinical relevance: Congenital aortic dilation may prompt evaluation for inherited connective tissue or molecular contributors to aortic disease.
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Q79.63— Vascular Ehlers-Danlos syndrome- Clinical relevance: A known hereditary connective tissue disorder strongly associated with vascular fragility; genetic testing for various loci may be relevant in a broader genetic evaluation.
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Q87.410— Marfan syndrome with aortic dilation- Clinical relevance: Syndromic aortic dilation in Marfan syndrome prompts genetic workup for inherited risk; ApoE genotyping can be part of cardiovascular risk modifier assessment.
Related CPT Codes
| CPT Code | Description | Relationship to 81411 |
|---|---|---|
81401 | Molecular pathology procedure, Level 2 | Alternative or lower complexity molecular testing; may be used for simpler targeted molecular tests when appropriate; not simultaneous if 81411 specifically performed. |
81403 | Molecular pathology procedure, Level 4 | Alternative mid-level molecular pathology; used for panels or assays of differing complexity compared with ApoE genotyping. |
81405 | Molecular pathology procedure, Level 6 | Higher complexity molecular pathology; may be used for more complex or comprehensive molecular analyses when ApoE analysis is part of a larger testing algorithm. |
81406 | Molecular pathology procedure, Level 7 | Highest complexity molecular pathology listed; potential alternative for extensive molecular testing workflows involving multiple gene targets. |
Common use: these codes represent other molecular pathology levels that may be billed instead of or in conjunction with 81411 depending on the exact test methodology and scope. Documentation should support whether tests are distinct versus components of a single ordered panel.
National Reimbursement Benchmarks
National commercial mean rates cluster above the BUCA (average commercial) mean of $1,022.46 for 81411, with Blue Cross Blue Shield at $1,086.55 and UnitedHealth Group at $1,063.91. Medicare is not included in the provided numeric input; comparison to Medicare is not available in the input.
Dispersion measured by the interquartile range (P75 − P25) varies notably across payers. Cigna shows the widest spread (P75 $1,489.00 − P25 $356.50 = $1,132.50), indicating substantial variability. Blue Cross Blue Shield and UnitedHealth Group show relatively tighter bands (BCBS IQR $550.00; UHC IQR $646.11). Aetna and BUCA have moderate dispersion (Aetna IQR $421.83; BUCA IQR $553.40). The table and chart below present the full percentile and mean-rate breakdown.
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