Summary & Overview
CPT 88245: Chromosome Analysis for Sister Chromatid Exchange
CPT code 88245 represents a cytogenetic laboratory procedure: chromosome analysis for Sister Chromatid Exchange (SCE) using cultured lymphocyte cells from blood or bone marrow, evaluating 20–25 cells for chromosomal breakage characteristics. This specialized test supports diagnosis and characterization of chromosomal instability and certain genetic or exposure-related conditions. Nationally, accurate coding and coverage of cytogenetic assays like 88245 influence access to diagnostic testing and laboratory service billing consistency.
Key payers in the coverage landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for SCE testing, typical sites where the service is performed, and the payer mix most often involved with this type of laboratory billing.
This publication provides benchmarks and policy-relevant details useful for laboratory billing specialists, medical coders, and policy analysts: clinical indications and the laboratory process implied by the code, payer coverage considerations and common modifiers used with laboratory services, and practical guidance on documentation elements aligned with the procedure description. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 88245 describes a chromosome analysis for Sister Chromatid Exchange (SCE) performed by a laboratory analyst. The procedure uses cultured lymphocyte cells from blood or bone marrow to identify a chromosomal breakage characteristic called SCE. The analysis includes evaluation of 20 to 25 cells for the presence of sister chromatid exchanges. Chromosomes are the DNA-containing structures within cells.
Service Type: Cytogenetic laboratory analysis — chromosomal breakage assay (SCE)
Typical Site of Service: Clinical laboratory or cytogenetics laboratory (blood or bone marrow specimen processing and microscopy)
Clinical & Coding Specifications
Clinical Context
A 32-year-old patient referred from hematology presents with unexplained chromosomal instability and suspected chromosomal breakage disorder after recurrent unexplained cytopenias and abnormal peripheral blood smear. The clinician orders a Sister Chromatid Exchange (SCE) analysis to evaluate chromosomal breakage characteristics using cultured lymphocytes from peripheral blood. Blood is collected in appropriate anticoagulant and sent to the cytogenetics laboratory. In the lab, a technologist cultures lymphocytes, incorporates bromodeoxyuridine (BrdU) to label sister chromatids, harvests metaphase cells, and prepares slides. A cytogeneticist or qualified laboratory analyst examines 20–25 metaphase cells microscopically to count SCEs per chromosome and documents increased exchange frequency when present. Results are reported to the ordering hematologist or genetics specialist for correlation with clinical findings and potential further genetic evaluation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Patient had a distinct procedural service | Used when SCE analysis is separately identifiable and not bundled with another laboratory service in the same encounter |
26 | Professional component |