cpt 81220, cpt code 81220, 81220 cpt code

CPT Code 81220 | Description, Procedure & Billing Guidelines (2022)

You can use CPT code 81220 to test for a panel of 23 common CFTR variants, as the ACMG/ACOG guidelines define. 

1. What Is CPT Code 81220?

CPT 81220 covers a technical lab test that aims to detect changes in the patient’s gene for the CFTR (Cystic Fibrosis Transmembrane conductance Regulator).

This procedure evaluates the CFTR mutations defined by guidelines of the American College of Obstetricians/American College of Medical Genetics, commonly associated with CF, containing a panel of 23 mutations.

2. Description

The CPT book describes CPT code 81220 as follows: “CFTR (cystic fibrosis transmembrane conductance regulator) (e.g., cystic fibrosis) gene analysis; common variants (e.g., ACMG/ACOG guidelines).”

3. Procedure

The description of CPT code 81220 means the following procedure. First, a lab analyst begins with the technical steps required for extracting the nucleic acids by techniques such as cell digestion and lysis.

These methods stabilize and increase the quantified nucleic acid so it can be analyzed by amplification. The lab analyst can detect the targeted genes using nucleic acid probes.

Clinicians often order the test described by CPT 81220 to identify couples with a baby wish who could pass cystic fibrosis to their offspring. Cystic fibrosis is often present in people with an Ashkenazi Jewish or Hispanic white background.

These common mutations will identify half to nearly all CF carriers depending on ethnicity. This test only identifies the most common mutations; therefore, a negative test does not ensure that the patient does not carry CF.

4. How To Use CPT Code 81220

Report one unit of CPT code 81220 for a single test for the most common variants of the CFTR as defined by ACMG/ACOG.

Patients with a positive R117H undergo, in most cases, Intron 8 poly–T analysis. Do not report CPT 81224 in addition to CPT 81220.

Make sure that you understand the differences between the CFTR tests. The following CPT codes are similar to the 81220 CPT code;

  • CPT 81221: Tests for CFTR known familial variants.
  • CPT 81222: Tests for CFTR duplication deletion variants.
  • CPT 81223: Tests for CFTR full gene sequence.
  • CPT 81224: Tests for CFTR intron 8 poly–T analysis.

Add modifier G0452 with modifier 26 and CPT 81220 if a clinician requests a physician to interpret the test results and write a report. According to CMS, this should be an MD or DO physician, not a Ph.D. laboratory scientist.

You may add other CPT codes to the 81220 code for prep work that precedes cell lysis and is documented. For example, you can use CPT 88262 for tissue selection from archived specimens, CPT 88380 for microdissection, or CPT 88387 and CPT 88388 for macroscopic dissection.

5. Resources

CPT Professional 2022

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=57141&ver=15&CoverageSelection=Local&ArticleType=All&PolicyType=Final&s=All&CptHcpcsCode=81432&bc=gAAAAAgAAAAA&=

https://www.aetna.com/cpb/medical/data/100_199/0140.html

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