2025 CPT code 81426
(Active) Effective Date: N/A Pathology and Laboratory Procedures - Genomic Sequencing Procedures and Other Molecular Multianalyte Assays Feed
Genome (e.g., unexplained constitutional or heritable disorder or syndrome); sequence analysis, each comparator genome (eg, parents, siblings) (List separately in addition to code for primary procedure)
Medical necessity for 81426 is established when the analysis of a comparator genome is deemed essential for the interpretation of the patient's whole genome sequence (81425) and contributes to the diagnosis, management, or genetic counseling related to a heritable condition.
The clinical responsibility for ordering and interpreting this test falls upon healthcare professionals such as clinical geneticists, medical geneticists, or other specialists involved in the diagnosis and management of genetic disorders. The ordering clinician must have evaluated the patient and obtained a detailed family history to understand the clinical context and potential relevance of the comparator genome analysis.
In simple words: A specialized genetic test examines the complete DNA sequence of a family member (parent or sibling) to serve as a comparison against the patient's DNA, helping to understand the cause of an inherited condition or unexplained symptoms in the patient.
This add-on code describes genomic sequencing performed on a comparator genome (e.g., parent, sibling) to analyze an unexplained constitutional or heritable disorder or syndrome. The test involves sequencing the entire genome of the comparator to create a reference that aids in evaluating the patient's genome and potential genetic variations contributing to the disorder. This code is used in conjunction with 81425 and is reported separately for each comparator genome analyzed.
Example 1: A newborn presents with multiple congenital anomalies and developmental delays. Whole genome sequencing (81425) is performed on the newborn, and to aid in interpretation, 81426 is reported for the sequencing of both parents' genomes to identify potential causative variants., A child exhibits features of a suspected genetic syndrome but lacks a definitive diagnosis. Whole genome sequencing is performed (81425), and the unaffected sibling’s genome is also sequenced (81426) to differentiate between de novo and inherited variants., An adult with a complex, undiagnosed neurological condition undergoes whole genome sequencing (81425), and parental genomes are sequenced (81426) to pinpoint potentially causative or contributory variants.
Documentation for 81426 should include the reason for testing (e.g., unexplained disorder, family history), the relationship of the comparator to the patient, and the interpretation of the comparator genome in the context of the patient's clinical presentation and genome sequencing results (reported with 81425).
- Specialties:Clinical Genetics, Medical Genetics, Pediatrics, Neurology, Oncology (in specific cases)
- Place of Service:Office, Independent Laboratory, Outpatient Hospital, Inpatient Hospital