The information contained in this website has been compiled by CodeMap, L.L.C. to assist Abbott 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 CodeMap.
For other questions, please contact the Abbott Reimbursement Helpline at (800) 553-7042, option 6.
Medicare FFS Claims: 2% Payment Adjustment (Sequestration) Changes
No payment adjustment through March 31, 2022
1% payment adjustment April 1 - June 30, 2022
2% payment adjustment beginning July 1, 2022
Fees Reflect 2022 CMS Medicare Fee Schedules
Important note regarding MolDx: AneuVysion Multicolor DNA Probe Kit (Vysis CEP 18, X, Y-alpha satellite, LSI 13 and 21)
has been assigned Z-Code ZB795.
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)
|Medicare Reimbursement Amount|
Please select state.
$288.62 X 2 = $577.23
$ 43.26 X 2 = $ 86.52
Morphometric analysis, in situ hybridization (quantitative or semi-quantitative), manual, per specimen; each multiplex probe stain procedure
Procedure Code: 88377 (1) X 2 (2)
|Medicare Reimbursement Amount|
Please select state.
$348.14 X 2 = $696.28
$ 63.68 X 2 = $127.35
When enumeration is performed by a cytotechnologist:
|Procedure Code||Procedure Description||Reimbursement Amount|| Units Billed
|88271||Molecular cytogenetics; DNA probe, each (eg, FISH)|| $ 21.42|
|88275||Molecular cytogenetics; interphase in situ hybridization, analyze 100-300 cells|| $ 51.19|
|88291*||Cytogenetics and molecular cytogenetics, interpretation and report || $ 33.57|
* 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 06/13/2022
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
The information contained in this website has been compiled by CodeMap, L.L.C. to assist Abbott customers in preparing and submitting claims to Federal health care programs and 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.
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