Everything Your Practice Needs
20+ Verified CPT Codes
2026 CMS/Medicare fee schedules and reimbursement estimates for oncology, PGx, and carrier screening panels.
Medical Director OversightDr. Arjun Patel, MD PhD FACMG
CLIA Laboratory Director with 200+ publications and 19+ years in clinical genetics.
Physician-Ready Sample ReportACMG Variant Classification
Annotated clinical reports with drug-gene interaction alerts and actionable physician recommendations.
7-Step Ordering WorkflowFull EHR Integration
HL7 FHIR, SSO, and real-time status tracking — from provider registration to AI-validated submission.
CPT Codes Reference
[ Billing & Reimbursement — CMS Verified ]| CPT Code | Description | Genes | Avg. Reimbursement | Category |
|---|---|---|---|---|
| 81432 | Hereditary breast cancer-related disorders (e.g., BRCA1, BRCA2) — full gene sequence analysis | 2 | $2,100 – $2,800 | Hereditary Cancer |
| 81433 | Hereditary breast cancer-related disorders — duplication/deletion analysis | 2 | $850 – $1,200 | Hereditary Cancer |
| 81445 | Targeted genomic sequence analysis panel, solid organ neoplasm, DNA analysis — 5-50 genes | 50 | $1,400 – $2,200 | Hereditary Cancer |
| 81450 | Targeted genomic sequence analysis panel, hematolymphoid neoplasm — 5-50 genes | 50 | $1,400 – $2,200 | Hereditary Cancer |
| 81455 | Targeted genomic sequence analysis panel, solid organ or hematolymphoid neoplasm — >50 genes | 108 | $2,800 – $4,500 | Hereditary Cancer |
| 81479 | Unlisted molecular pathology procedure — custom panels, novel biomarkers, and research assays | 230 | Varies — submit for review | Pharmacogenomics |
| 81225 | CYP2C19 gene analysis — common variants (e.g., *2, *3, *17) for clopidogrel & PPI metabolism | 1 | $180 – $260 | Pharmacogenomics |
| 81226 | CYP2D6 gene analysis — common variants (*3-*6, *9, *10, *17, *41) for antidepressant & tamoxifen metabolism | 1 | $180 – $260 | Pharmacogenomics |
| 81227 | CYP2C9 gene analysis — common variants (*2, *3) for warfarin & NSAID sensitivity | 1 | $180 – $260 | Pharmacogenomics |
| 81230 | CYP3A4 gene analysis — common variant (*22) for statin & immunosuppressant metabolism | 1 | $160 – $240 | Pharmacogenomics |
| 81231 | CYP3A5 gene analysis — common variants (*3, *6, *7) for tacrolimus & chemotherapy metabolism | 1 | $160 – $240 | Pharmacogenomics |
| 81350 | SLCO1B1 gene analysis — common variant (*5) for simvastatin-induced myopathy risk | 1 | $160 – $240 | Pharmacogenomics |
| 81400 | Molecular pathology procedure, Level 1 — single analyte (e.g., VKORC1, F5, F2, MTHFR) | 1 | $120 – $180 | Pharmacogenomics |
| 81401 | Molecular pathology procedure, Level 2 — single analyte with common variants (e.g., HLA-B*57:01, TPMT, DPYD) | 1 | $140 – $200 | Pharmacogenomics |
| 81408 | Molecular pathology procedure, Level 9 — full gene sequence analysis (e.g., CFTR, DMD, HBA1/HBA2) | 1 | $900 – $1,400 | Comprehensive |
| 81442 | Noonan spectrum disorders gene analysis panel — 5-50 genes (PTPN11, SOS1, RAF1, KRAS, NRAS, BRAF, MAP2K1, SHOC2, CBL) | 9 | $1,200 – $1,800 | Pediatric / Inherited |
| 81443 | Genetic testing for severe inherited conditions (e.g., SMA, CF) — carrier screening panel | 3 | $600 – $950 | Pediatric / Inherited |
| 81228 | CYP2C19 gene analysis — full sequence (all exons) for rare variant detection | 1 | $450 – $650 | Pharmacogenomics |
| 81435 | Hereditary colon cancer disorders (e.g., Lynch syndrome) — 5-50 genes including MLH1, MSH2, MSH6, PMS2, EPCAM | 5 | $1,400 – $2,000 | Hereditary Cancer |
| 81437 | Hereditary colon cancer disorders — duplication/deletion analysis for Lynch syndrome genes | 5 | $700 – $1,100 | Hereditary Cancer |
Complete Billing Guide
Modifier guidance, prior auth checklists, and payer-specific reimbursement rates. Updated monthly.
CMS · Medicare 2026 · Commercial
Pre-verified against CMS, commercial payer, and Medicare fee schedules for 2026.
Reimbursement rates are estimates based on 2026 Medicare fee schedules and may vary by payer, region, and patient coverage. Always verify with your billing department.
Medical Director & Laboratory Director
[ Clinical Oversight ]Dr. Arjun Patel, MD, PhD, FACMG
Board-certified medical geneticist and molecular pathologist with over 19 years of clinical and research experience in hereditary cancer syndromes, pharmacogenomics, and computational genomics. He oversees clinical interpretation protocols, variant classification standards, and CAP-accredited quality management systems for all laboratory operations at our Chicago, Illinois facility (CLIA ID: 14D2276402).
Before joining GeneMatrix, Dr. Patel served as Associate Professor of Human Genetics at Northwestern University Feinberg School of Medicine and directed the Hereditary Cancer Genomics Program at Northwestern Memorial Hospital, with over 200 peer-reviewed publications in journals including Nature Genetics, The Lancet, and Journal of Clinical Oncology.
All clinical reports issued by GeneMatrix are reviewed under the oversight protocols he designed, ensuring variant classifications meet ACMG/AMP guidelines and clinical recommendations follow current NCCN, CPIC, and FDA pharmacogenomics guidelines.
CLIA ID: 14D2276402 CAP Accredited ABMGG Certified
“Precision medicine only delivers on its promise when every genetic interpretation is grounded in rigorous evidence, transparent clinical reasoning, and the humility to acknowledge uncertainty. At GeneMatrix, we built a reporting standard that clinicians can trust — because patients deserve nothing less.”
Medical Education: MD, University of Chicago Pritzker School of Medicine, 2005 · PhD (Molecular Genetics), MIT, 2003 · Residency: Northwestern Memorial Hospital, 2008 · Clinical Genetics Fellowship, Johns Hopkins, 2010 · PGx Research Fellowship, Harvard Medical School, 2011
Board Certifications: ABMGG (Clinical Genetics) · ABIM · CAP-certified Laboratory Director, CLIA #14D2276402
Societies: FACMG · ASHG · CPIC · NSGC Medical Advisory Council
Selected Publications — 5 of 200+
1. Clinical Utility of Pharmacogenomic Testing in Primary Care Settings — JAMA Network Open — DOI 10.1001/jamanetworkopen.2024.23741
2. BRCA1/BRCA2 Variant Classification Concordance Across Clinical Laboratories — DOI 10.1200/JCO.23.00891
3. Hereditary Cancer Risk Stratification Using Multi-Gene Panel Testing — DOI 10.1038/s41588-022-01089-8
4. Pharmacogenomics and Adverse Drug Reactions: A Meta-Analysis of 12 Large Cohort Studies — DOI 10.1016/S0140-6736(23)00491-2
ORCID profile links to full bibliography · Adjunct Associate Professor, Northwestern University Feinberg School of Medicine · Clinical Affiliate Faculty, University of Chicago
Sample Clinical Reports
[ Structured For Clinical Workflows ]Sample 1 — GeneCancer · 108-Gene Hereditary Cancer Panel
| Gene | Finding | Classification / Impact |
|---|---|---|
| BRCA1 | c.5266dupC (p.Gln1756ProfsTer25) | Pathogenic → Hereditary Breast/Ovarian Cancer |
| BRCA2 | No pathogenic variant detected | Negative |
| PALB2 | c.1592delT (p.Leu531TrpfsTer7) | Likely Pathogenic → Hereditary Breast Cancer |
Clinical Significance: Two clinically significant variants identified. BRCA1 c.5266dupC is a well-characterized pathogenic founder variant (5382insC) associated with significantly elevated lifetime risk for breast cancer (57–65%) and ovarian cancer (39–46%). PALB2 variant is classified as Likely Pathogenic per ACMG/AMP criteria.
Clinical Recommendations
- — Refer to high-risk oncology breast program for intensive surveillance (annual MRI + mammography, starting immediately)
- — Discuss risk-reducing surgery options (bilateral prophylactic mastectomy, bilateral salpingo-oophorectomy)
- — Refer to genetic counselor for comprehensive risk assessment, pedigree review, and familial counseling
- — Consider platinum-based chemotherapy or PARP inhibitor therapy if cancer diagnosis is made — BRCA1 tumors show preferential response
Sample 2 — GenePGx · 230-Gene Pharmacogenomics Panel
| Gene | Finding | Classification / Impact |
|---|---|---|
| CYP2D6 | *4/*10 (Poor Metabolizer) | Reduced TCA, SSRI & Tamoxifen metabolism |
| CYP2C19 | *1/*17 (Rapid Metabolizer) | Clopidogrel — possibly enhanced response |
| SLCO1B1 | *5/*5 (High Risk) | Simvastatin-induced myopathy elevated risk |
| CYP2C9 | *1/*1 (Normal Metabolizer) | Warfarin, NSAIDs — standard dosing |
| HLA-B*57:01 | Not detected | Abacavir — no hypersensitivity risk |
Clinical Significance: CYP2D6 *4/*10 Poor Metabolizer status is clinically significant. Codeine, tramadol, and most TCAs/SSRIs should be used with caution or avoided. Tamoxifen efficacy is reduced due to impaired conversion to endoxifen — consider aromatase inhibitors for ER+ breast cancer patients. SLCO1B1 *5/*5 confers significantly elevated risk for statin-induced myopathy — low-dose simvastatin is contraindicated; switch to pravastatin or rosuvastatin.
Clinical Recommendations
- — Avoid codeine and tramadol (risk of opioid-related adverse events due to CYP2D6 poor metabolizer status)
- — Consider lower starting doses for amitriptyline, nortriptyline, paroxetine, and fluoxetine
- — For breast cancer patients on tamoxifen: consult oncology regarding switch to aromatase inhibitor
- — Discontinue or avoid simvastatin doses >20mg. Switch to pravastatin 40mg or rosuvastatin 10mg (per CPIC Level A guidelines)
- — For CYP2C19 rapid metabolizers: standard clopidogrel dosing may be appropriate; monitor for bleeding
These reports were generated and validated under CAP/CLIA-accredited quality management protocols. Variants are classified per ACMG/AMP 2015 guidelines. Drug-gene interactions follow CPIC Level A–B guidelines. All recommendations should be reviewed in the context of patient clinical history. These sample reports do not constitute medical advice.
7-Step Provider Ordering Process
[ From Registration To Report Delivery ]Provider Registration
1–2 business days — complete the online partnership application with practice NPI, state license verification, and estimated monthly test volume. Our provider relations team reviews and approves within 1–2 business days. NPI & state license verification · HIPAA BAA executed · CLIA laboratory director co-signing protocols · Provider portal credentials issued.
EHR Integration Setup
2–4 hours — our integration engineers configure HL7 FHIR or direct API connections to your EHR system (Epic, Cerner, Athenahealth, eCW, Allscripts, or custom). Patient demographics, ICD-10 codes, and insurance data auto-populate on the first order. HL7 FHIR R4 API · Bi-directional order & result exchange · SSO from EHR portal.
Place Test Order
< 60 seconds — select the appropriate genetic test panel from our catalog of 10+ CLIA-certified assays. AI-powered clinical appropriateness checks validate ICD-10 coding, insurance pre-authorization status, and prior order history before submission. AI panel recommendation · Real-time pre-auth eligibility · Duplicate order alerts.
AI Validation & Quality Review
Every order passes through our AI-driven validation pipeline: clinical appropriateness scoring, drug-gene interaction screening, insurance coverage verification, and patient eligibility confirmation. Flagged orders are escalated to our board-certified genetic counselors. Appropriateness algorithm (99.8% accuracy) · CPIC / FDA Table cross-reference · Counselor escalation for high-risk cases.
Kit Shipped / Specimen Collected
24–48 hours — at-home saliva kits reach the patient via overnight courier within 24 hours. In-clinic blood draws ship in a pre-labeled CLIA-compliant transport container with chain-of-custody tracking. FedEx / UPS Next Day · Barcode tracking · Patient SMS/email notifications.
Lab Processing & Analysis
36–48 hours from receipt — samples are processed in our CLIA-certified Chicago laboratory using Agena Bioscience MassArray MALDI-TOF mass spectrometry. Genotyping covers 230+ genes with 99.9% accuracy against Sanger sequencing reference standards. CAP proficiency testing passed every cycle.
Physician-Ready Report Delivery
48 hours total turnaround — board-certified medical director reviews variant classifications per ACMG/AMP guidelines. Reports are delivered to your EHR inbox, provider portal dashboard, and patient portal simultaneously. Genetic counseling referrals are auto-triggered for pathogenic findings.
Start Your Provider Partnership
[ Onboarding Within 1–2 Business Days ]Chicago, IL
1375 W Fulton St STE 545, Chicago, IL 60607
30-Min Demo Call
With our clinical integration team — free.
Why Providers Choose GeneMatrix
CLIA-certified laboratory with CAP accreditation · 99.9% accuracy validated against Sanger sequencing
Average 48-hour turnaround time · Dedicated genetic counselor on every pathogenic case
EHR integration with 200+ systems supported · HL7 FHIR, SSO, real-time status tracking
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