2025 CPT code 88291
(Active) Effective Date: N/A Revision Date: N/A Laboratory - Cytogenetic Studies Pathology and Laboratory Procedures Feed
Interpretation and report of cytogenetic and molecular cytogenetic testing.
Modifiers may be applicable depending on the circumstances of service.Refer to the CPT manual for specific modifier guidelines.
Medical necessity for cytogenetic and molecular cytogenetic testing is established based on clinical indications, such as suspected chromosomal abnormalities, family history of genetic disorders, prenatal screening, or cancer diagnosis.The referring physician must provide sufficient clinical information to justify the need for the testing.
A qualified provider, typically a pathologist, is responsible for reviewing the cytogenetic and molecular cytogenetic test results, interpreting the findings in the context of the patient's clinical information, and generating a comprehensive report with recommendations.
In simple words: A doctor, usually a pathologist, reviews lab test results that look at chromosomes and genes to check for problems. They explain the results and give advice based on the patient's health history.
This CPT code encompasses the interpretation and reporting of cytogenetic and molecular cytogenetic tests.A qualified provider, typically a pathologist, reviews results of procedures such as chromosome analysis, karyotyping, and in situ hybridization. They interpret the assay results, considering additional patient medical information, and provide a comprehensive report including analysis and recommendations.
Example 1: A patient presents with unexplained developmental delays.Cytogenetic analysis is performed to identify potential chromosomal abnormalities, such as aneuploidy or structural rearrangements.The pathologist reviews the karyotype, interprets the findings, and prepares a report for the referring physician, including potential diagnoses and recommendations for further evaluation., A patient is diagnosed with leukemia.Molecular cytogenetic studies, such as fluorescence in situ hybridization (FISH), are used to detect specific chromosomal translocations or gene fusions characteristic of different leukemia subtypes. The pathologist analyzes the FISH results, correlates them with the patient's clinical presentation, and provides a detailed report to guide treatment decisions., A pregnant woman undergoes prenatal screening.Amniocentesis is performed, and cytogenetic analysis is used to evaluate the fetus's chromosomes for abnormalities like Down syndrome or other aneuploidies. The pathologist interprets the results, providing information to the obstetrician and genetic counselor to assist the parents in making informed decisions regarding the pregnancy.
* Patient demographics and relevant clinical history.* Detailed description of the cytogenetic/molecular cytogenetic test performed.* Raw data from the test (e.g., karyotype images, FISH results).* Pathologist's interpretation and analysis of the results.* Diagnostic and therapeutic recommendations.
** This code is for the professional interpretation and reporting of cytogenetic studies only.The technical component of the testing is billed separately using appropriate codes.
- Revenue Code: T1G (LAB TESTS - OTHER)
- RVU: Refer to the CMS Physician Fee Schedule for current RVUs and reimbursement rates.These values vary by geographic location and facility type.
- Payment Status: Active
- Modifier TC rule: Not applicable.This code represents professional interpretation and reporting, not a technical component.
- Fee Schedule: The historical fee schedule for this code is not readily available.However, the CMS Physician Fee Schedule database can provide historical payment rates.
- Specialties:Medical Genetics, Cytogenetics, Pathology, Oncology, Obstetrics/Gynecology
- Place of Service:Office, Hospital (Inpatient/Outpatient), Ambulatory Surgical Center, Laboratory