Billing and Coding: Lab: Bladder/Urothelial Tumor Markers

Medicare A/B MAC covers bladder tumor marker FISH testing (notably the FDA‑approved UroVysion™ assay) when performed using validated assays on urine specimens for initial diagnosis in patients with hematuria and for monitoring recurrence in patients with prior bladder cancer. Claims must be submitted by CLIA‑certified laboratories using CPT 88120 or 88121 (enter 1 UOS), include an appropriate ICD‑10 diagnosis code, and follow component‑specific billing rules (TC modifier for technical component; physicians must personally perform and document the professional interpretation).

"FISH bladder tumor marker testing performed using validated assays on urine specimens from persons with hematuria suspected of having bladder cancer to aid initial diagnosis."

Sign up to see full coverage criteria, indications, and limitations.