2025 CPT code 81240
(Active) Effective Date: N/A Revision Date: N/A Laboratory - Molecular Pathology Procedures Pathology and Laboratory Feed
Analysis of the F2 gene (prothrombin, coagulation factor II) for the 20210G>A variant, associated with hereditary hypercoagulability.
Modifier 26 may be appended for physician interpretation and report. Other modifiers may apply depending on the specific circumstances of service.
Medical necessity is established based on the patient's clinical presentation, symptoms suggestive of hypercoagulability, and family history.Payer policies may vary and should be consulted to determine specific criteria for coverage.
The clinical responsibility lies primarily with the laboratory analyst who performs the technical aspects of the test. A physician or qualified healthcare professional may provide interpretation and reporting of the results (billed separately).
In simple words: This lab test checks for a specific gene change (a variant) in the prothrombin gene. This gene is involved in blood clotting. The change being tested for is linked to a condition where the blood clots too easily. The test helps doctors diagnose this condition and determine the best course of treatment.
This CPT code encompasses the technical component of genetic testing for the F2 gene (prothrombin, coagulation factor II).The analysis specifically targets the 20210G>A variant, a common mutation linked to hereditary hypercoagulability. The procedure includes all analytical steps, from nucleic acid extraction (e.g., cell lysis, digestion) and amplification to detection using methods like nucleic acid probes.Other variants may also be included in the analysis but are not reported separately. Physician interpretation and report is billed separately using modifier 26 and code G0452 (if applicable).
Example 1: A patient presents with recurrent deep vein thrombosis (DVT).The physician orders 81240 to investigate the possibility of hereditary thrombophilia related to the F2 gene variant., A pregnant woman with a history of recurrent miscarriages undergoes genetic testing, including 81240, to assess for inherited hypercoagulability as a potential contributing factor., A patient with a family history of thrombotic disorders undergoes genetic testing, including 81240, as part of a preventative care strategy.
Detailed patient history including symptoms, family history of thrombotic disorders, and any previous thrombotic events.Lab requisition clearly indicating the specific test requested (81240).Complete and accurate patient demographics.
** This code is specific to the 20210G>A variant of the F2 gene. If other variants are tested, they are included in this code and not reported separately.Always confirm payer-specific coverage and reimbursement policies before billing.
- RVU: Relative Value Units (RVUs) are not assigned by the AMA and are not part of CPT.
- Payment Status: Active
- Modifier TC rule: This code represents the professional component of the test. The technical component is included in the code.
- Fee Schedule: Historical fee schedules vary by payer and location. Consult payer-specific fee schedules for historical data.
- Specialties:Hematology, Thrombosis, Genetics, Cardiology
- Place of Service:Laboratory