Summary & Overview
CPT 81475: Cytogenomic Microarray Analysis for Chromosomal Abnormalities
CPT code 81475 represents cytogenomic constitutional (genome-wide) microarray analysis, a critical genetic testing procedure used to detect copy number variants and constitutional chromosomal abnormalities. This code is widely recognized in clinical genetics for its role in diagnosing conditions such as Down syndrome, Edwards syndrome, and other chromosomal abnormalities. The procedure is typically performed in laboratory settings and is essential for providing detailed genomic information that informs patient care and clinical decision-making.
Blue Cross Blue Shield is a key payer covering this service, reflecting its importance in both commercial and public health insurance programs. Readers will gain insights into the clinical context of 81475, including its relevance for genetic diagnostics, common billing practices such as the use of modifier codes 26 and TC, and associated provider taxonomies. The publication also highlights related CPT codes and ICD-10 diagnoses, offering a comprehensive overview of how this procedure fits into broader genetic testing and pathology workflows. Policy updates and reimbursement benchmarks are discussed to provide a clear understanding of current trends and payer coverage for this essential genetic analysis.
CPT Code Overview
CPT code 81475 is used for cytogenomic constitutional (genome-wide) microarray analysis, specifically for the interrogation of genomic regions to identify copy number variants such as constitutional chromosomal abnormalities. This procedure falls under the category of genetic testing and is typically performed in a laboratory setting (Place of Service 81). The test plays a crucial role in diagnosing and understanding genetic conditions by providing comprehensive genomic information.
Clinical & Coding Specifications
Clinical Context
A child presents to a genetics clinic with developmental delays and dysmorphic features. The clinical team suspects a chromosomal abnormality and orders cytogenomic constitutional (genome-wide) microarray analysis using CPT code 81475. The workflow involves collecting a blood sample, which is sent to a laboratory (Place of Service 81) for analysis. A clinical geneticist or molecular genetic pathologist interprets the results to identify copy number variants that may explain the patient's symptoms. The findings are then discussed with the family and used to guide further management.
Coding Specifications
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Modifiers:
- Modifier
26: Used when reporting only the professional component (interpretation of the test results). - Modifier
TC: Used when reporting only the technical component (performance of the laboratory test).
- Modifier
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207SG0201X | Clinical Genetics (M.D.) |
207SC0300X | Medical Genetics, Ph.D. Medical Genetics |
207SG0202X | Molecular Genetic Pathology |
These taxonomies represent providers specializing in clinical genetics, medical genetics, and molecular genetic pathology.
Related Diagnoses
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Q90.9: Down syndrome, unspecified- Relevant for patients with features suggestive of Down syndrome; microarray analysis can confirm chromosomal abnormalities.
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Q93.9: Chromosomal abnormality, unspecified- Used when a chromosomal abnormality is suspected but not yet defined; microarray analysis helps identify specific variants.
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Q92.9: Trisomy and partial trisomy of autosomes, unspecified- Applicable for suspected trisomy or partial trisomy; microarray analysis detects these chromosomal changes.
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Q99.9: Chromosomal abnormality, unspecified- Used for broad suspicion of chromosomal abnormalities; microarray analysis provides detailed genomic information.
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Q91.9: Edwards syndrome, unspecified- Relevant for patients with clinical features of Edwards syndrome; microarray analysis can confirm the diagnosis.
Related CPT Codes
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81228: Cytogenomic constitutional (genome-wide) microarray analysis; interrogation of genomic regions for copy number variants- Related as a similar procedure focusing on copy number variants; may be used as an alternative to
81475depending on clinical specifics.
- Related as a similar procedure focusing on copy number variants; may be used as an alternative to
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81229: Cytogenomic constitutional (genome-wide) microarray analysis; interrogation of genomic regions for copy number variants and single nucleotide polymorphisms- Expands on
81228by including single nucleotide polymorphism analysis; may be used together or as an alternative to81475.
- Expands on
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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 if the testing performed is not covered by
81475.
- Used when a molecular pathology procedure does not have a specific CPT code; may be used if the testing performed is not covered by
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81470: X-linked intellectual disability (XLID) genomic sequence analysis panel- Focuses on X-linked intellectual disability; may be ordered in cases where XLID is suspected, as an alternative or complement to
81475.
- Focuses on X-linked intellectual disability; may be ordered in cases where XLID is suspected, as an alternative or complement to
National Reimbursement Benchmarks
For CPT code 81475, the national mean rate for Blue Cross Blue Shield and BUCA (average commercial) is $80.02. Medicare rates are not available in the input for comparison. Both commercial payers, Blue Cross Blue Shield and BUCA, have identical mean rates, indicating uniformity in national reimbursement levels for this code.
Rate dispersion is minimal across these payers, with the 25th, 50th, and 75th percentiles all at $80.00. This suggests a very tight range, with no variation between the lower and upper quartiles. The table and chart below present the full breakdown of national benchmarks for CPT code 81475.
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.