2025 CPT code 88199
(Active) Effective Date: N/A Pathology and Laboratory - Cytopathology Procedures Pathology and Laboratory Feed
Unlisted cytopathology procedure.
Modifiers may be applicable to 88199 depending on the specific circumstances. Common modifiers include 26 (professional component) and TC (technical component). Modifier 59 may be appropriate in certain limited cases if the unlisted service is distinct from other services provided on the same day.
Medical necessity must be established for all procedures billed with 88199.The documentation must clearly indicate why the procedure was performed and how it relates to the patient's condition and treatment plan. When an unlisted code is used, strong justification related to medical necessity is even more critical for claim acceptance and reimbursement.
The clinical responsibility for this code falls on the pathologist or other qualified healthcare professional performing and interpreting the cytopathology procedure. They are responsible for ensuring the accuracy of the test, documenting the findings, and communicating the results to the referring physician.
In simple words: This code is used for lab tests involving the study of cells to diagnose diseases, when no other specific code exists for the particular test performed.A detailed explanation of the test is sent with the bill to explain why this general code was used and what was done.
This code is used for cytopathology procedures that are not described by other specific CPT codes. It is essential to submit supporting documentation with the claim when using this unlisted code to ensure proper processing and reimbursement.This would typically include a detailed description of the procedure performed, the clinical indication, and the interpretation of the results.
Example 1: A patient presents with a complex thyroid nodule. Fine needle aspiration is performed, and the sample is prepared using a novel technique not described by other CPT codes for cytopathological evaluation. Code 88199 would be reported along with detailed documentation of the procedure., A new immunocytochemical stain is developed for the detection of a rare genetic marker in bladder cancer cells.A patient's urine sample is analyzed using this novel staining technique. Since there is not a specific CPT code for this stain, 88199 would be reported., A patient has a pleural effusion. A sample of the fluid is sent for cytopathologic analysis using a new, experimental cell sorting technique. As no existing CPT code describes this technique, the procedure would be reported with 88199.
Detailed documentation should be submitted to support the use of 88199. This should include a description of the procedure performed, the clinical indication, and the results interpretation. The documentation must support the medical necessity of the procedure.Any novel methods or experimental techniques employed should be clearly described. Comparison to similar existing procedures may be beneficial for accurate billing.
- Revenue Code: T1G - LAB TESTS - OTHER (MEDICARE FEE SCHEDULE)
- Payment Status: Active
- Modifier TC rule: The TC modifier can apply if the physician is billing only for the technical component of the procedure. This would generally not be the case with cytopathology, as both the professional and technical components are typically performed together.
- Specialties:Pathology, and any specialty that performs and interprets cytopathology procedures (e.g., oncology, surgery, gynecology).
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Independent Laboratory, and potentially other places of service depending on where the procedure is performed.