Summary & Overview
CPT 81472: CYP2C19 Genetic Testing for Drug Metabolism
CPT code 81472 represents genetic testing for the CYP2C19 gene, a critical component in determining how patients metabolize certain medications. This test identifies common genetic variants that can influence drug efficacy and safety, making it a valuable tool in personalized medicine and pharmacogenomics. Nationally, the use of CPT 81472 is expanding as healthcare providers seek to tailor treatments based on genetic information, improving outcomes and reducing adverse drug reactions.
Blue Cross Blue Shield is a key payer covering this service, reflecting broader trends in payer adoption of genetic testing for drug metabolism. Readers will gain insight into clinical benchmarks, policy updates, and the evolving role of genetic testing in medical practice. The publication also provides context on laboratory billing practices, typical sites of service, and related codes for other cytochrome P450 gene analyses. Understanding CPT 81472 is essential for stakeholders navigating the intersection of clinical genetics, laboratory operations, and payer policy.
CPT Code Overview
CPT 81472 is used to report genetic testing for the analysis of the CYP2C19 gene, which is part of the cytochrome P450 family. This test identifies common variants such as *2, *3, *4, *8, and *17 that can impact drug metabolism. The service type is genetic testing, and it is typically performed in a laboratory setting (Place of Service 81). This code is essential for guiding medication management and optimizing therapeutic outcomes based on individual genetic profiles.
Clinical & Coding Specifications
Clinical Context
A patient is referred for genetic testing to evaluate their CYP2C19 gene variants, which influence drug metabolism. This is commonly performed in a laboratory setting (POS 81) when a provider needs to determine how a patient may respond to certain medications, such as antiplatelet drugs used in cardiovascular disease. The workflow typically involves a physician ordering the test, a laboratory collecting and analyzing the sample, and a medical geneticist or molecular pathologist interpreting the results. The findings may guide medication selection or dosing, especially in patients with a history of atherosclerotic heart disease or acute myocardial infarction.
Coding Specifications
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Modifiers:
26: Professional Component – Used when only the interpretation of the genetic test is performed by a physician or specialist.TC: Technical Component – Used when only the laboratory performs the technical aspects of the test, such as sample processing and analysis.
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Provider Taxonomies:
Taxonomy Code Specialty Name 207SG0201XMedical Genetics, Ph.D. Medical Genetics 207ZP0213XPathology, Molecular Genetic Pathology 207Q00000XFamily Medicine Physician -
Specialties Represented:
- Medical Genetics
- Molecular Genetic Pathology
- Family Medicine
Related Diagnoses
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Z13.79: Encounter for other screening for genetic and chromosomal anomalies- Relevant for patients undergoing genetic screening to identify CYP2C19 variants.
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Z15.89: Genetic susceptibility to other disease- Used when testing is performed to assess genetic risk factors for disease, such as cardiovascular conditions influenced by drug metabolism.
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Z51.81: Encounter for therapeutic drug level monitoring- Applicable when genetic testing is part of monitoring drug levels and optimizing therapy.
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I25.10: Atherosclerotic heart disease of native coronary artery without angina pectoris- Indicates a clinical scenario where pharmacogenetic testing may guide antiplatelet therapy.
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I21.9: Acute myocardial infarction, unspecified- Used for patients with acute myocardial infarction, where CYP2C19 testing can inform medication management.
Related CPT Codes
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81225: CYP2C9 (cytochrome P450, family 2, subfamily C, polypeptide 9) (e.g., drug metabolism), gene analysis, common variants- Used for analyzing CYP2C9 gene variants, which also affect drug metabolism. May be ordered alongside
81472for comprehensive pharmacogenetic profiling.
- Used for analyzing CYP2C9 gene variants, which also affect drug metabolism. May be ordered alongside
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81226: CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (e.g., drug metabolism), gene analysis, common variants- Assesses CYP2D6 gene variants, relevant for metabolism of different medications. Often used in conjunction with
81472.
- Assesses CYP2D6 gene variants, relevant for metabolism of different medications. Often used in conjunction with
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81227: CYP3A4 (cytochrome P450, family 3, subfamily A, polypeptide 4) (e.g., drug metabolism), gene analysis, common variants- Evaluates CYP3A4 gene variants, which impact metabolism of various drugs. May be part of a broader pharmacogenetic panel.
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81479: Unlisted molecular pathology procedure- Used when a molecular pathology procedure does not have a specific CPT code. May be used as an alternative if testing falls outside the scope of
81472.
- Used when a molecular pathology procedure does not have a specific CPT code. May be used as an alternative if testing falls outside the scope of
National Reimbursement Benchmarks
For CPT code 81472, the national mean rate for Blue Cross Blue Shield and the BUCA commercial average is $80.02. Medicare rates are not available in the input for comparison. Both commercial payers show identical mean rates, indicating no difference between Blue Cross Blue Shield and the broader BUCA average.
Rate dispersion is minimal across these payers, with the 25th, 50th, and 75th percentiles all at $80.00. This reflects a very tight reimbursement range nationally, with no variation between the lower and upper quartiles for either payer. The table and chart below present the full breakdown of national benchmarks for CPT code 81472.
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.