MDS FISH

Medicare covers FISH testing for suspected myelodysplastic syndrome (MDS) only when conventional karyotyping is inadequate (fewer than 20 metaphases or an unresolved karyotype) and documentation shows a bone marrow exam suggestive of MDS. Coverage is limited to up to four specified FISH probes (-7/del(7q), -5/del(5q), +8, del(20q)) on initial evaluation; additional reflex probes are reasonable only if those initial studies are negative or diagnostic uncertainty persists. Generally, FISH is not covered when conventional karyotype provides an adequate cytogenetic assessment.

"Coverage is allowed when a patient's bone marrow examination is suggestive of myelodysplastic syndrome (MDS) and there is an inadequate cytogenetic assessment by conventional karyotyping."

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