Summary & Overview
CPT 81432: Genomic Sequencing Panel for Hereditary Breast Cancer
CPT code 81432 represents a genomic sequencing panel designed to detect mutations in at least five genes linked to hereditary breast cancer. This advanced molecular diagnostic tool is increasingly important in clinical practice, offering comprehensive genetic insights that inform patient care and risk assessment. The code is widely recognized by major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, reflecting its clinical relevance and broad coverage.
This publication provides an in-depth overview of 81432, including payer coverage, clinical context, and related coding benchmarks. Readers will gain clarity on the scope of the procedure, typical laboratory settings, and its role in the evolving landscape of molecular pathology. Policy updates and coding trends are also discussed, helping stakeholders understand the implications for reimbursement and utilization. The analysis highlights the importance of genomic sequencing in hereditary breast cancer management and outlines how this code fits within broader laboratory and pathology services.
Key takeaways include payer coverage details, clinical applications, and the relationship of 81432 to other relevant CPT codes. The publication serves as a resource for understanding the national significance of this code in both clinical and billing contexts.
CPT Code Overview
CPT code 81432 is used for genomic sequence analysis panels that evaluate patient specimens for genetic sequences of at least five genes associated with hereditary breast cancer mutations. This procedure identifies both sequence variants and copy number variants, providing critical information for the diagnosis and management of hereditary breast cancer-related disorders. The service falls under Pathology and Laboratory Procedures – Genomic Sequencing Procedures and Other Molecular Multianalyte Assays and is typically performed in a laboratory setting (Place of Service 81).
Clinical & Coding Specifications
Clinical Context
A patient with a personal or family history suggestive of hereditary breast cancer presents to their healthcare provider. The provider orders a genomic sequencing panel to evaluate for mutations in at least five genes associated with hereditary breast cancer. The specimen is collected and sent to a laboratory (Place of Service 81) specializing in molecular genetics. The laboratory performs sequence analysis and copy number variant interrogation to identify pathogenic mutations. Results are interpreted by a medical geneticist and reported back to the provider for clinical management.
Coding Specifications
-
Modifiers:
26: Professional Component – Used when only the interpretation of the test is performed by the provider, not the technical execution.TC: Technical Component – Used when only the technical execution of the test (e.g., running the assay) is performed, not the interpretation.
-
Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207SG0201X | Medical Genetics, Ph.D. Medical Genetics |
207SC0300X | Medical Genetics, Clinical Genetics (M.D.) |
207SG0202X | Medical Genetics, Clinical Biochemical Genetics |
207SG0203X | Medical Genetics, Clinical Cytogenetics |
207SG0205X | Medical Genetics, Clinical Molecular Genetics |
These taxonomies represent providers specializing in medical genetics, including Ph.D. and M.D. clinical genetics, biochemical genetics, cytogenetics, and molecular genetics.
Related Diagnoses
C56.3: [No description provided]- This ICD-10 code is associated with the clinical scenario for hereditary breast cancer-related genetic testing. It is relevant for patients with a diagnosis or suspicion of a breast cancer-related disorder, supporting the medical necessity for genomic sequencing procedures.
Related CPT Codes
-
81433: Hereditary breast cancer-related disorders, duplication/deletion analysis- Used for targeted analysis of gene duplications or deletions related to hereditary breast cancer. May be performed in conjunction with
81432for comprehensive evaluation.
- Used for targeted analysis of gene duplications or deletions related to hereditary breast cancer. May be performed in conjunction with
-
81211: BRCA1, BRCA2 gene analysis, full sequence analysis- Focuses specifically on BRCA1 and BRCA2 genes. Can be used as an alternative or complement to
81432when only BRCA genes are of interest.
- Focuses specifically on BRCA1 and BRCA2 genes. Can be used as an alternative or complement to
-
81212: BRCA1, BRCA2 gene analysis, known familial variants- Used when testing for specific known familial BRCA variants. May be ordered alongside or instead of
81432in certain family scenarios.
- Used when testing for specific known familial BRCA variants. May be ordered alongside or instead of
-
81213: BRCA1, BRCA2 gene analysis, duplication/deletion variants- Targets duplication/deletion variants in BRCA genes. Can be used with
81432for expanded analysis.
- Targets duplication/deletion variants in BRCA genes. Can be used with
-
81479: Unlisted molecular pathology procedure- Used for molecular pathology procedures not otherwise specified. May be used when testing falls outside the scope of
81432or related codes.
- Used for molecular pathology procedures not otherwise specified. May be used when testing falls outside the scope of
National Reimbursement Benchmarks
For CPT code 81432, the national mean rate for BUCA (average commercial) is $653.99, which is higher than the mean rate for Aetna ($576.76), Cigna ($688.01), and UnitedHealth Group ($596.53), but lower than Blue Cross Blue Shield at $803.78. Medicare rates are not available in the input for comparison.
Rate dispersion, measured as the difference between the 75th and 25th percentiles, varies significantly across payers. Blue Cross Blue Shield shows the widest spread at $568.00, indicating substantial variability in rates. Cigna also has a wide dispersion of $612.50. In contrast, Aetna has a tighter range of $251.11, and UnitedHealth Group is similarly tight at $373.00. BUCA's range is $413.00, reflecting moderate variability.
The table and chart below present the full breakdown of national mean rates and percentile values 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.