Does 88291 require prior authorization?

No, 88291 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 88291?

Medicare facility rate: $33.07. Non-facility rate: $33.07. Work RVU: 0.51.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.51

Facility

$33.07

Non-Facility

$33.07

Medical necessity for the test must be documented (e.g., diagnosis of CLL, documentation of ≥1 prior therapy, and documentation that the patient is a potential candidate for venetoclax).
The performing laboratory must be CLIA‑certified and CLIA certification must be available for claims review.
To bill the professional component, documentation must show that a pathologist read and interpreted the raw data; technician/scientist‑only interpretation cannot be billed as the professional component.
Claims must include the appropriate CPT codes and specified units of service per the billing guidance and indicate whether enumeration was performed and by whom.

The Vysis CLL FISH Probe Kit (unmodified, Abbott) is covered as the FDA‑approved companion diagnostic to detect 17p deletion in patients with B‑cell chronic lymphocytic leukemia (CLL) who have received at least one prior therapy and who are potential candidates for venetoclax, when medically necessary.
Cover FISH testing to detect 17p deletion for patients with B-cell chronic lymphocytic leukemia (CLL) who have received at least one prior therapy and who are potential candidates for venetoclax.
Cover detection of 17p deletion only when performed using validated assays; the FDA-approved Vysis CLL FISH Probe Kit (Abbott Molecular) is the validated companion diagnostic for venetoclax.
Allow billing and Medicare reimbursement for the unmodified Vysis CLL FISH Probe Kit by Abbott Molecular when the above clinical criteria are met.
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).

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

Ask Verity about documentation requirements, denial risks, or coverage in your state.