88274
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
- Claims for MDS FISH must include the appropriate CPT code and an appropriate ICD-10-CM diagnosis code; a DEX Z-Code identifier is not required for FISH testing.
- Submit the appropriate CPT code on the claim and report 1 unit of service (UOS).
- Include the appropriate ICD-10-CM diagnosis code on the claim.
- A DEX Z-Code identifier is not required; if submitted it must be entered adjacent to the CPT code in the comment/narrative field: for Part B electronic 5010A1 837P use Loop 2400 or SV101-7, for Part B paper use Box 19, for Part A electronic 837I use Line SV202-7, and for 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, distinguishing qualitative versus quantitative methods (computer-assisted versus manual).
- 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 versus quantitative/computer-assisted versus manual analysis).
- 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).
16 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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