The information contained in this website has been compiled by CodeMap, L.L.C. to assist Abbott Molecular customers. CodeMap, L.L.C. remains solely responsible for its content. The information provided is for general educational purposes only and may not be conclusive or exhaustive. Recent changes in applicable law, regulations and interpretations may not be reflected in the information contained herein. For technical questions, please contact Dr. Charles Root.

For other questions, please contact the Abbott Molecular Reimbursement Helpline at (800) 553-7042, option 6.


While sequestration is in effect, all CMS payments for services will be reduced by 2%.
The fees below do not reflect this reduction. Click here for more information.



      FISH
            AneuVysion®
      RealTime PCR
            RealTime CT/NG
            RealTime CMV
            RealTime HBV
            RealTime HCV
            RealTime HCV Genotype II
            RealTime HIV-1

      Sequencing
            ViroSeq HIV-1 Genotyping System

      FISH
            PathVysion® HER-2 DNA Probe Kit
            UroVysion®
            Vysis ALK Break Apart FISH Probes Kit
            Vysis CLL FISH Probe Kit
            Vysis EGR1 FISH Probes Kit

      RealTime PCR
            RealTime IDH1®
            RealTime IDH2®
Vysis CLL FISH Probes Kit

U.S. Medicare Part B Reimbursement for
Fees Reflect 2018 CMS Medicare Fee Schedules

Vysis CLL FISH Probe Kit


Using computer-assisted technology:
Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), using computer-assisted technology, per specimen; each multiplex probe stain procedure

Procedure Code: 88374 (1) X 2 (2)   CCI   MUE  
Medicare Reimbursement Amount
Global Fee $315.40 X 2 = $630.80
Technical Component $271.55 X 2 = $543.10
Professional Fee $ 43.85 X 2 = $ 87.70

Manual:
Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; each multiplex probe stain procedure

Procedure Code: 88377 (1) X 2 (2)   CCI   MUE  

Medicare Reimbursement Amount
Global Fee $375.57 X 2 = $751.14
Technical Component $311.78 X 2 = $623.56
Professional Fee $ 63.79 X 2 = $127.58


When enumeration is performed and reviewed by a cytotechnologist:

Procedure Code
Procedure Description
Reimbursement Amount
Units Billed
Total Payment
88271
  CCI   MUE   NCD
Molecular cytogenetics; DNA probe, each (eg, FISH)
$ 26.44
4
$ 105.76
88275
  CCI   MUE   NCD
Molecular cytogenetics; interphase in situ hybridization, analyze 100-300 cells
$ 51.19
1
$ 51.19
88291*
  CCI   MUE   NCD
Cytogenetics and molecular cytogenetics, interpretation and report
$ 31.50
1
$ 31.50
Total Payment Amount:
$ 188.45
* Procedure Code 88291 may be reported if a separate report is provided by a pathologist. The findings must be in writing and signed.

(1) Tests using procedure codes 88374 and 88377 are on the Medicare Part B Physician Fee Schedule and require physician or pathologist review and interpretation. If the test is interpreted by a cytotechnologist, procedure codes 88271 and 88275 are applicable. Procedure code 88291 may be reported if a separate report is provided by a pathologist. The findings must be in writing and signed. The January 2016 National Correct Coding Initiative Manual (Chapter 10, page 15) notes:

  "When in situ hybridization is performed on tissue or cellular specimens by a non-physician (provider other than M.D./D.O.), it should be reported using appropriate CPT codes in the range 88271-88275."

"The physician (limited to M.D./D.O.) work component of 88364-88369, 88373, 88374, 88377 requires that a physician (limited to M.D./D.O.) rather than laboratory scientist or technician read, quantitate (88367-88369, 88373, 88374, 88377), and interpret the tissues/cells stained with the probe(s). If this work is performed by a laboratory scientist or technician, CPT codes 88271-88275 should be reported."

(2) Although the code descriptors indicate that the unit of service is for each multiplex probe staining procedure per specimen, the January 2016 edition of the National Correct Coding Initiative Manual (Chapter 10, page 22) indicates the following:

  "The unit of service for in situ hybridization reported as CPT codes 88364-88369, 88373, 88374, 88377 is each single or multiplex probe staining procedure per specimen. If a single or multiplex probe staining procedure is performed on multiple blocks from a surgical specimen, multiple slides from a cytologic specimen, or multiple slides from a hematologic specimen, only one unit of service may be reported for each separate specimen. Physicians should not report more than one unit of service for CPT codes 88366, 88374, or 88377 per specimen for each multiplex probe staining procedure even if it contains multiple separately interpretable probes."


PLEASE consult with your payer to confirm the appropriate unit of service to report for this test.

LOINC Codes-Updated 3/29/2018

Under the MolDx program, certain molecular tests require a Z-Code(TM) identifier in addition to the appropriate CPT code. Services within the scope of this program require the Z-Code(TM) to be submitted as additional information at the time of claim submission in order to be fully adjudicated Laboratories performing these molecular tests may be required to register with the MolDx program for each molecular pathology test they furnish. For more information on the MolDx program, registration and covered procedures, please click here: https://www.palmettogba.com/palmetto/MolDX.nsf

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12/10/2018 04:21:48