Wiki CPT Code 88291

[tamstrnd]

Good day everyone! If someone out there could please let me know if this Cytogenetics and molecular cytogenetics, interpretation and report has to be signed only by a physician or can a Ph.D. sign on these as well? Thank you so much! Tammy

 

[ladym62]

CPT code 88291

As of 12/31/2012 CPT code 88291 was discontinued and replaced w/ G0452, which is to be used for the interp and report only. You will find this information here Pathology Changes 2013 - American Medical Association.

I hope this helps.

Molecular Pathology Tests to Be Paid on CLFS New molecular pathology test codes will be placed and priced on the clinical laboratory fee schedule (CLFS) in 2013, the Centers for Medicare and Medicaid Services (CMS) has determined. For tests that require a physician interpretation, CMS is creating a new code for use on the physician fee schedule – G code G0452 – that will be use to pay pathologists for their professional work in interpreting results.

CMS announced its decision in the final physician fee schedule rule, released Nov. 1. The agency said after reviewing comments, it believes “that the molecular pathology CPT codes describe clinical diagnostic laboratory tests that should be paid under the CLFS because these services do not ordinarily require interpretation by a physician to produce a meaningful result.”

CMS has not yet released its final CLFS for 2013 but is expected to any day now. The agency previously had indicated that it will use gap-filling methodology to price the tests. Under the gap-fill method, local Medicare contractors set the payment rate based on local pricing patterns.

While the agency said it does not believe molecular pathology tests are ordinarily performed by physicians, it acknowledge that in some case a physician interpretation of a molecular pathology test may be medically necessary. “In order to make PFS payment for that interpretation, on an interim basis for CY 2013, we have created HCPCS G-code G0452 (molecular pathology procedure; physician interpretation and report) to describe medically necessary interpretation and written report of a molecular pathology test, above and beyond the report of laboratory results.” For this code, CMS is assigning a work RVU of 0.37 and 5 minutes of pre-service time, 10 minutes of intra-service time, and 5 minutes of post-service time.

Physicians can also continue to receive payment for the current clinical pathology consultation CPT codes 80500 and 80502 if the pathology consultation service relating to a molecular pathology test meets the definition of those codes.

 

[vegjas12]

Cpt 88291

Cytogenetic Interpretation, 88291 is still a valid CPT. Only 83912 has been replaced with G0452. You should continue to bill 88291 for Interpretation of Cytogenetic tests.

 

[chrisman4]

88291

We are billing 88291 with a 90 modifier because the CYG test are send outs. Medicare is rejecting this code for missing/invalid modifier. Any thoughts?

 

[jacquelynvaldivia]

88291 with 90 modifier

Has anyone had success billing Medicare for 88291 w/90 modifier? We're having a difficult time finding guidance. I am in So California, Noridian Jurisdiction E.