Does 88374 require prior authorization?

No, 88374 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 88374?

Medicare facility rate: $226.79. Non-facility rate: $226.79. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

$226.79

Non-Facility

$226.79

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.
Genetic testing CPT codes are covered when testing is reasonable and necessary per Local Coverage Determination L39365 and the AMA CPT Codebook and Medicare NCCI Policy Manual instructions are followed.
If a CPT code specifies a medical condition (e.g., CPT 81432 - hereditary breast cancer-related disorders), bill that code only when the beneficiary's documented disease matches the code's described medical condition and all genes billed under that code relate to that condition.

A59492 — Billing and Coding: Genetic Testing for Oncology

J09

A59491 — Billing and Coding: Genetic Testing for Oncology

J12

AMBETTER-CG-Onc-Cytogenetics-2025.1 — Concert Genetic Oncology: Cytogenetic Testing

A56008 — Billing and Coding: FDA Approved CLL Companion Diagnostic Test

A56050 — Billing and Coding: FDA Approved CLL Companion Diagnostic Test

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