Cytogenetic Studies

06/09/2020

Date Issued: 6/09/2020
 

EmblemHealth has been implementing payment policies that reflect guidelines set forth by industry authorities. Our goal is to process claims consistently and in accordance with best practice standards. EmblemHealth has instituted a payment policy for cytogenetic studies, the microscopic examination of the physical appearance of human chromosomes as defined by CMS.
 

According to CMS policy, cytogenetic studies are covered for specific clinical conditions such as genetic disorders in a fetus, failure of sexual development, chronic myelogenous leukemia, acute leukemias (lymphoid, myeloid, unclassified), and myelodysplasia. Cytogenetic studies (88230-88291) will be denied if reported without an approved diagnosis.
 

https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=198&ncdver=1&bc=AAAAQAAAAAAA&

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