Summary & Overview
CPT 81427: Reevaluation of Full Genomic Sequence Analysis
CPT code 81427 represents the reevaluation of a patient's full genomic sequence analysis by a laboratory analyst, prompted by new clinical information or evidence of an unrelated condition that was not available during the initial evaluation. This procedure is a critical component of genomic medicine, enabling clinicians to update genetic interpretations as new data emerges, which can impact patient management and treatment decisions. The code is categorized under Genomic Sequencing Procedures and Other Molecular Multianalyte Assays, reflecting its role in advanced molecular diagnostics.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, provide coverage for this service, underscoring its widespread clinical relevance. Readers will gain insight into payer coverage benchmarks, recent policy updates, and the clinical context for the use of 81427. The publication also explores associated taxonomies, common modifiers, and related CPT codes, offering a comprehensive overview of how this code fits into the broader landscape of medical genetics and laboratory services.
This summary provides a clear understanding of the importance of 81427 in the evolving field of genomic medicine, highlighting its utility for ongoing patient care and its recognition by leading health insurers.
CPT Code Overview
CPT code 81427 is used when a laboratory analyst reevaluates an existing patient full genomic sequence analysis in light of new information that was not available at the time of the initial evaluation. This may include new clinical information or evidence of an unrelated condition. The service falls under Genomic Sequencing Procedures and Other Molecular Multianalyte Assays and is typically performed in a laboratory setting (Place of Service 81). This code is essential for updating and refining genetic assessments as new data emerges, supporting ongoing patient care and precision medicine.
Clinical & Coding Specifications
Clinical Context
A patient previously underwent full genomic sequencing to evaluate for genetic risk factors or unexplained clinical findings. New clinical information has emerged, such as updated family history, new symptoms, or evidence of an unrelated condition. The laboratory analyst is requested to reevaluate the patient's existing genomic sequence in light of this new information. This process is performed in a laboratory setting (Place of Service 81) and typically involves specialists in medical genetics. The workflow includes reviewing the original genomic data, integrating new clinical or genetic evidence, and providing an updated interpretation to inform patient management.
Coding Specifications
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Modifier
26: Used to indicate the professional component of the service, where only the interpretation and reporting are performed by the provider. -
Modifier
59: Used to indicate a distinct procedural service, when the procedure is separate from other services performed on the same day.
| Modifier Code | Description |
|---|---|
26 | Professional Component |
59 | Distinct Procedural Service |
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Associated Provider Taxonomies:
207SG0201X: Medical Genetics, Ph.D. Medical Genetics207SC0300X: Medical Genetics, Clinical Genetics (M.D.)207SG0202X: Medical Genetics, Clinical Biochemical Genetics207SG0203X: Medical Genetics, Clinical Cytogenetics207SG0205X: Medical Genetics, Clinical Molecular Genetics
These taxonomies represent providers specializing in various aspects of medical genetics, including clinical, biochemical, cytogenetic, and molecular genetics.
Related Diagnoses
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Z15.01: Genetic susceptibility to malignant neoplasm of breast- Relevant for patients with identified genetic risk factors for breast cancer, prompting genomic reevaluation.
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C50.919: Malignant neoplasm of unspecified site of unspecified female breast- Indicates a diagnosis of breast cancer, which may necessitate genomic analysis for treatment or risk assessment.
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Z80.3: Family history of malignant neoplasm of breast- Used when there is a family history of breast cancer, supporting the need for genetic evaluation.
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Z84.81: Family history of carrier of genetic disease- Indicates a family history of genetic disease carriers, relevant for genomic risk assessment.
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Z13.79: Encounter for other screening for genetic and chromosomal anomalies- Used for patients undergoing screening for genetic or chromosomal anomalies, which may lead to reevaluation of genomic data.
Related CPT Codes
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81426: The lab analyst performs a gene sequence analysis of the entire genome in a relative of the patient to create a reference genome gene sequence, which the lab analyst can compare to the patient’s genome to evaluate an unexplained disorder or syndrome.- This code is related to
81427as it may be used to establish a reference genome for comparison, especially in cases of unexplained disorders.
- This code is related to
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81430: The lab analyst performs a genomic sequence analysis panel to evaluate the patient specimen for genetic sequences of at least 60 genes, including 16 genes that the code descriptor lists, which may relate to hearing loss.- This code is related to
81427as it involves targeted genomic analysis, which may be performed in conjunction with or as an alternative to full genome reevaluation.
- This code is related to
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These codes may be used together in workflows where both patient and relative genomes are analyzed, or where a panel analysis is needed alongside a full genome reevaluation.
National Reimbursement Benchmarks
Nationally, the mean rate for CPT code 81427 among commercial payers (BUCA) is $1,644.69, which is substantially higher than the mean rate for Aetna at $529.92. Blue Cross Blue Shield, Cigna, and UnitedHealth Group all report mean rates above $1,700, with UnitedHealth Group at $1,849.43, the highest among the listed payers.
Rate dispersion, measured as the difference between the 75th and 25th percentiles, varies significantly across payers. Cigna exhibits the widest spread at $2,003.33, followed by Blue Cross Blue Shield at $1,236.00. UnitedHealth Group and BUCA have moderate dispersions of $1,122.25 and $1,182.00, respectively. Aetna shows no dispersion, with all percentile values at $0.00, indicating either a lack of contracted rates or limited data for this code. The table and chart below present the full breakdown of national benchmarks for CPT code 81427.
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