2025 CPT code 81185
(Active) Effective Date: N/A Revision Date: N/A Laboratory - Molecular Pathology Procedures Pathology and Laboratory Procedures Feed
Analysis of the complete CACNA1A gene sequence, identifying variations associated with conditions like spinocerebellar ataxia type 6 (SCA6).
Modifiers may be appended as clinically indicated.For instance, modifier 26 may be used if only interpretation and reporting are performed by the physician.Modifier 59 may be necessary to indicate distinct procedural services performed on the same day.
Medical necessity is established by the patient's clinical presentation, family history of relevant neurological disorders, or other supporting clinical evidence suggestive of a CACNA1A-related condition.Payers may require specific clinical information to justify the test.
The clinical responsibility rests primarily with the laboratory personnel who perform the technical aspects of the test. Physician interpretation of the results may be separately reported (e.g., using G0452 with modifier 26).
In simple words: This lab test examines the entire CACNA1A gene to look for any changes or variations in its sequence.These variations can be related to neurological disorders like spinocerebellar ataxia, which affects movement and coordination. The test involves multiple steps to analyze the gene's DNA thoroughly.
This CPT code encompasses the comprehensive analysis of the entire CACNA1A gene sequence.The procedure involves multiple steps, starting with nucleic acid extraction (e.g., using cell lysis and digestion), followed by amplification (e.g., polymerase chain reaction or PCR) to increase the quantity of nucleic acids for analysis, and concluding with the detection of target gene sequences. The analysis identifies variations within the gene, which may be linked to various neurological conditions, notably including spinocerebellar ataxia type 6 (SCA6).The results are qualitative.
Example 1: A patient presents with symptoms suggestive of spinocerebellar ataxia type 6 (SCA6), including progressive gait ataxia and difficulty with coordination.The physician orders a full gene sequence analysis of CACNA1A to confirm the diagnosis., A family history of episodic ataxia type 2 (EA2) is present.Genetic testing of family members is ordered to identify those who are carriers of CACNA1A gene variants, to facilitate genetic counseling and family planning., A patient experiences recurrent episodes of hemiplegic migraine.Given that CACNA1A variants can be involved in familial hemiplegic migraine, full gene sequencing is performed to investigate the underlying genetic cause.
The documentation should include the patient's clinical history and symptoms, the reason for ordering the test, the specimen collected (e.g., blood), the date of collection, and the results of the genetic analysis.If a physician interpretation is provided separately, that report should also be documented.
** Payers may have specific requirements for reimbursement, including documentation of medical necessity and appropriate clinical indications.It is crucial to maintain accurate documentation and adhere to payer-specific guidelines.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier is not directly applicable to this code as it represents a comprehensive gene analysis performed by the laboratory.
- Specialties:Neurology, Genetics, Clinical Laboratory
- Place of Service:Clinical Laboratory