CPT Code for BRCA Testing

 

Medical providers and insurance companies must have a static and universally understandable way of communicating with one another, especially as this pertains to billing. Codifications allows each party to create and honor invoices in a timely fashion. The CPT code for BRCA testing is one example of this.

This is basically a series of numbers and letters that are used by medical billing specialists to let insurers know that a specific type of test or procedure has been performed. In this instance, this particular code is related to examinations that are done to determine whether or not hereditary cancers exist. Thus, they are commonly used for patients within the same family who are concerned about their genetic predisposition to a specific forms of illness.

Some companies may not cover this type of examination unless there is adequate evidence that it is necessary. For instance, a more basic plan will not pay for services that are deemed as being frivolous if no major risks for the patient are evident. When multiple family members have developed the illness and early testing and diagnosis can improve the possible prognosis for the patient, however, this may be deemed a worthwhile endeavor.

A number of additional codes are likely to present on the patient’s billing records in order to assure insurance providers that adequate measures were taken to determine this test necessary. For instance, a person might have a blood draw performed in order to have a genetic review or a cheek cell sample taken. Given that people inherit genes from both parents, certain traits may not be dominant and are therefore less likely to have an impact on individual health.

This particular form of coding is vital for ensuring that providers are paid for their services. When symptom of an illness exist, the need for testing is obvious. When there is concern due to genetic predisposition, however, providers will usually need to justify this concern through other forms of examination or research so that insurers are willing to honor and pay for these services.

below are the codes available  for BRCA Testing :

CPT 81211 BRCA1, BRCA2 (breast cancer 1 and 2) (eg, hereditary breast and ovarian
cancer) gene analysis; full sequence analysis and common
duplication/deletion variants in BRCA1 (ie, exon 13 del 3.835kb, exon 13
dup 6kb, exon 14-20 del 26kb, exon 22 del 510bp, exon 8-9 del 7.1kb)
CPT 81212 BRCA1, BRCA2 (breast cancer 1 and 2) (eg, hereditary breast and ovarian
cancer) gene analysis; 185delAG, 5385insC, 6174delT variants
CPT 81213 BRCA1, BRCA2 (breast cancer 1 and 2) (eg, hereditary breast and ovarian
cancer) gene analysis; uncommon duplication/deletion variants
CPT 81214 BRCA1 (breast cancer 1) (eg, hereditary breast and ovarian cancer) gene
analysis; full sequence analysis and common duplication/deletion variants
(ie, exon 13 del 3.835kb, exon 13 dup 6kb, exon 14-20 del 26kb, exon 22
del 510bp, exon 8-9 del 7.1kb)
CPT 81215 BRCA1 (breast cancer 1) (eg, hereditary breast and ovarian cancer) gene
analysis; known familial variant
CPT 81216 BRCA2 (breast cancer 2) (eg, hereditary breast and ovarian cancer) gene
analysis; full sequence analysis
CPT 81217 BRCA2 (breast cancer 2) (eg, hereditary breast and ovarian cancer) gene
analysis; known familial variant

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