88271
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Submit the appropriate CPT code on the claim when reporting an MDS FISH service.
- Enter 1 unit of service (UOS) on the claim for each reported MDS FISH CPT code.
- Include the appropriate ICD-10-CM diagnosis code on the claim when reporting MDS FISH.
- A DEX Z-Code identifier is not required; if submitted, place the DEX Z-Code adjacent to the CPT code in the comment/narrative field as follows: Part B electronic (5010A1 837P) use Loop 2400 or SV101-7; Part B paper use Box 19; Part A electronic (837I) use Line SV202-7; UB04 use Block 80.
Key Coverage Criteria
- Use CPT codes 88271-88291 when in situ hybridization (ISH) is performed as an ancillary analysis to cytogenetic studies for oncologic or inherited disorders.
- Use CPT codes 88365-88377 when a pathologist performs ISH techniques as an adjunct to a surgical pathology or cytopathology case (distinguishes qualitative vs quantitative analysis).
- Use CPT 88271-88291 when in situ hybridization (ISH) is performed as an ancillary analysis to cytogenetic studies for oncologic or inherited disorders.
- Use CPT 88365-88377 when a pathologist performs ISH techniques as an adjunct to a surgical pathology or cytopathology case (to distinguish qualitative vs quantitative analysis).
- Cover FISH probes for patients whose bone marrow examination is suggestive of myelodysplastic syndrome (MDS) and who have an inadequate cytogenetic assessment by conventional karyotyping.
- Perform MDS FISH studies when there are fewer than 20 metaphases available for analysis or when the conventional karyotype is unresolved.
20 Active Policies
L37772 — MDS FISH
J05
A57576 — Billing and Coding: MDS FISH
J05
CGS-L37608 — MDS FISH
J18 MAC Part B
WPS-L37772 — MDS FISH
J8 MAC Part B
NORIDIAN-L37620 — MDS FISH
JF Part B
Related Codes
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