How To Use CPT Code 81430

CPT 81430 describes the genomic sequence analysis panel used to evaluate a patient’s specimen for genetic sequences related to hearing loss. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 81430?

CPT 81430 can be used to describe the genomic sequence analysis panel performed by a lab analyst to evaluate a patient’s specimen for genetic sequences associated with hearing loss. This code specifically requires the sequencing of at least 60 genes, including CDH23, CLRN1, GJB2, GPR98, MTRNR1, MYO7A, MYO15A, PCDH15, OTOF, SLC26A4, TMC1, TMPRSS3, USH1C, USH1G, USH2A, and WFS1.

2. Official Description

The official description of CPT code 81430 is: ‘Hearing loss (eg, nonsyndromic hearing loss, Usher syndrome, Pendred syndrome); genomic sequence analysis panel, must include sequencing of at least 60 genes, including CDH23, CLRN1, GJB2, GPR98, MTRNR1, MYO7A, MYO15A, PCDH15, OTOF, SLC26A4, TMC1, TMPRSS3, USH1C, USH1G, USH2A, and WFS1.’

3. Procedure

1. The lab analyst collects a patient specimen, such as blood, for the genomic sequence analysis panel.
2. Using specialized equipment, such as a next-generation gene sequencer, the lab analyst performs a genomic sequence analysis of at least 60 genes, including the specific genes listed in the code descriptor.
3. The instrument used in the analysis determines the order of nucleotides in the DNA and reports the sequence as a string of letters.
4. The lab analyst compares the patient’s sequence to a reference genome of the same genes to identify any variations or mutations that may be associated with hearing loss.
5. The results of the analysis can aid in the diagnosis of certain conditions involving hearing loss and help distinguish between different genetic disorders, such as nonsyndromic hearing loss, Usher syndrome, and Pendred syndrome.

4. Qualifying circumstances

CPT 81430 is used for patients who require evaluation for genetic sequences related to hearing loss. This test may be ordered for genetic counseling, to aid in the diagnosis of certain conditions involving hearing loss, and to distinguish between different genetic disorders such as nonsyndromic hearing loss, Usher syndrome, and Pendred syndrome. The test must include the sequencing of at least 60 genes, including the specific genes listed in the code descriptor.

5. When to use CPT code 81430

CPT code 81430 should be used when a genomic sequence analysis panel is performed to evaluate a patient’s specimen for genetic sequences associated with hearing loss. This code is appropriate when at least 60 genes, including the specific genes listed in the code descriptor, are sequenced. It is important to note that this code should not be reported if CPT code 81431, which involves duplication and deletion analysis, is performed instead.

6. Documentation requirements

To support a claim for CPT code 81430, the following documentation is required:

• Patient’s diagnosis or reason for ordering the genomic sequence analysis panel
• Specific genes included in the analysis
• Date of the analysis
• Results of the analysis, including any variations or mutations identified
• Signature of the lab analyst performing the analysis

7. Billing guidelines

When billing for CPT code 81430, ensure that the genomic sequence analysis panel includes the sequencing of at least 60 genes, including the specific genes listed in the code descriptor. It is important to distinguish between CPT code 81430 and 81431, which involves duplication and deletion analysis. If both analyses are performed, both codes may be reported. It is also worth noting that some payers may separately reimburse for the collection of the patient specimen using a different code, such as 36415 for venous blood collection.

8. Historical information

CPT code 81430 was added to the Current Procedural Terminology system on January 1, 2015. There have been no updates or changes to the code since its addition.

9. Examples

1. A lab analyst performs a genomic sequence analysis panel on a patient’s specimen to evaluate genetic sequences associated with hearing loss.
2. A physician orders a genomic sequence analysis panel to aid in the diagnosis of a patient with suspected Usher syndrome.
3. A genetic counselor recommends a genomic sequence analysis panel to distinguish between different genetic disorders causing hearing loss in a patient.
4. A lab analyst performs a genomic sequence analysis panel on a patient’s specimen to identify variations or mutations associated with nonsyndromic hearing loss.
5. A physician orders a genomic sequence analysis panel to evaluate a patient’s specimen for genetic sequences related to Pendred syndrome.
6. A lab analyst performs a genomic sequence analysis panel on a patient’s specimen to aid in genetic counseling for a family with a history of hearing loss.
7. A geneticist recommends a genomic sequence analysis panel to evaluate a patient’s specimen for genetic sequences associated with progressive vision loss and hearing loss.
8. A lab analyst performs a genomic sequence analysis panel on a patient’s specimen to identify variations or mutations in genes associated with hearing loss and thyroid disease.