Summary & Overview
CPT 81470: Genomic Sequencing for Intellectual Disability Detection
CPT code 81470 represents a genomic sequencing procedure aimed at detecting genes associated with intellectual disability. This code is significant in the national landscape as it supports the identification of genetic causes for intellectual disability, which can inform clinical care and patient management. The procedure is typically performed in CLIA-certified laboratories and is recognized by major payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.
Readers will gain insight into payer coverage policies, relevant clinical contexts, and associated billing practices for this code. The publication covers benchmarks, policy updates, and the clinical importance of genomic sequencing in intellectual disability. It also highlights common modifiers used in billing, associated taxonomies for provider types, and relevant ICD-10 diagnoses. Additionally, related CPT codes are discussed to provide a comprehensive view of the coding landscape for intellectual disability genetic testing. This summary equips stakeholders with the information needed to understand the role and reimbursement environment for CPT code 81470 across the United States.
CPT Code Overview
CPT code 81470 is used for genomic sequencing procedures that detect genes associated with intellectual disability. This test falls under the Pathology and Laboratory – Genomic Sequencing Procedures service type and is typically performed in a laboratory setting, most often in a CLIA-certified lab designated as Place of Service 81. The procedure is designed to identify genetic factors contributing to intellectual disability, supporting clinical decision-making and patient management.
Clinical & Coding Specifications
Clinical Context
A child presents to a family medicine physician with developmental delays and learning difficulties. After initial evaluation and history, the physician refers the patient for genetic testing to investigate potential underlying causes of intellectual disability. The test is performed in a CLIA-certified laboratory (Place of Service 81) by a clinical pathology specialist. The workflow involves sample collection, genomic sequencing, and interpretation of results to identify genes associated with intellectual disability. The results may inform further management and counseling for the patient and family.
Coding Specifications
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Modifiers:
GX: Used when a notice of liability is issued voluntarily under payer policy, such as when Blue Cross Blue Shield, Cigna Health, or UnitedHealthcare require notification for non-covered services.GY: Applied when the item or service is statutorily excluded and does not meet the definition of any Medicare benefit, or for non-Medicare insurers (Aetna, BCBS, Cigna Health, UHC, BUCA), is not a contract benefit.
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207ZP0213X | Pathology - Clinical Pathology/Laboratory Medicine |
207Q00000X | Family Medicine Physician |
207R00000X | Internal Medicine Physician |
These taxonomies represent the specialties typically involved in ordering, performing, or interpreting the genomic sequencing procedure.
Related Diagnoses
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Z13.79: Encounter for other screening for genetic and chromosomal anomalies- Relevant for patients undergoing genetic testing to screen for intellectual disability-related anomalies.
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Z79.899: Other long term (current) drug therapy- May be documented if the patient is on long-term medication, which could be relevant in the context of genetic testing for intellectual disability.
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Z51.81: Encounter for therapeutic drug level monitoring- Used if drug level monitoring is part of the patient's ongoing care, though not directly related to the genetic test.
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I25.10: Atherosclerotic heart disease of native coronary artery without angina pectoris- Included as a possible comorbidity or unrelated diagnosis; not directly relevant to intellectual disability testing.
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I21.9: Acute myocardial infarction, unspecified- May be present in the patient's history but is not directly related to the genomic sequencing for intellectual disability.
These diagnoses may be documented in the patient's record, but only Z13.79 is directly relevant to the procedure described by 81470.
Related CPT Codes
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81471: X‑linked intellectual disability genomic sequence analysis panel duplication/deletion- Used for more targeted analysis when X-linked intellectual disability is suspected. May be ordered in conjunction with or as an alternative to
81470depending on clinical findings.
- Used for more targeted analysis when X-linked intellectual disability is suspected. May be ordered in conjunction with or as an alternative to
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81407: L1CAM gene sequencing (as referenced in related MolDX billing guidance)- Used for sequencing the L1CAM gene, which is associated with certain intellectual disabilities. This code may be used when a specific gene is indicated based on clinical or family history.
These codes are related to 81470 and may be used together or as alternatives in the diagnostic workflow for intellectual disability.
National Reimbursement Benchmarks
National mean rates for CPT code 81470 among commercial payers are highest with Blue Cross Blue Shield at $812.32, while the BUCA average is $720.76. Compared to typical Medicare rates, commercial mean rates are substantially higher, though Medicare data is not available in the input for this code.
Rate dispersion varies significantly across payers. Cigna shows the widest spread, with a difference of $753.00 between its 75th and 25th percentiles, indicating substantial variability in reimbursement. In contrast, Aetna has the tightest range at $319.60, suggesting more consistent rates across providers. Blue Cross Blue Shield and UnitedHealth Group also display moderate dispersion, with ranges of $274.00 and $444.00, respectively.
The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.
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.