Billing and Coding: Bladder/Urothelial Tumor Markers

Medicare covers urine-based FISH bladder tumor marker testing (CPT 88120/88121) when performed using validated assays (UroVysion is the FDA-approved assay) by CLIA-certified laboratories for initial diagnosis in patients with hematuria and for surveillance of recurrence in previously diagnosed bladder cancer patients. Claims must include appropriate CPT, 1 unit of service, ICD-10 diagnosis, and DEX Z-Code registration/technical assessment per MolDX; billing is limited to one tumor marker test per date of service and to the specified annual frequency limits during years 1–15 of follow-up.

"FISH bladder tumor marker testing (CPT 88120 or 88121) is covered when performed using validated assays (e."

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