Summary & Overview

CPT 88261: Chromosome Analysis with Banded Karyotype

CPT code 88261 represents a cytogenetic chromosome analysis in which an analyst examines genetic material, counts five cells, and produces a single banded karyotype image. Chromosome analysis is used to detect numerical and structural chromosomal abnormalities that inform diagnoses in oncology, prenatal testing, congenital anomaly evaluation, and other genetic disorders. Nationally, this code captures an important diagnostic laboratory service with implications for clinical decision-making and downstream genetic counseling and testing.

Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context and typical sites of service, common billing modifiers, and which payers commonly reimburse cytogenetic analyses. The publication outlines benchmarks and payment considerations where available, highlights coding and documentation elements relevant to laboratory workflows, and summarizes policy or coverage trends that could affect utilization and reimbursement. This resource is intended to help revenue cycle, laboratory management, and clinical teams understand how CPT code 88261 is used and where to look for payer-specific policies and coverage guidance.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 88261cytogeneticskaryotypechromosome analysislaboratory proceduregenetic testingclinical laboratorydiagnostic testingmedical coding

Billing Code Overview

CPT code 88261 describes a chromosome analysis performed by a laboratory analyst. The test examines a person’s genetic material for chromosomal abnormalities by counting five cells and producing one karyotype with banding, which is a photographic representation of the chromosomes.

Service type: Cytogenetic laboratory procedure

Typical site of service: Clinical laboratory / hospital laboratory

Data not available in the input for payers, associated taxonomies, ICD-10 diagnoses, and related codes.

Clinical & Coding Specifications

Clinical Context

A 32-year-old pregnant woman is referred to a genetics laboratory after abnormal first-trimester screen results and ultrasound findings suggestive of fetal structural anomalies. The obstetrician orders a fetal karyotype to evaluate for chromosomal aberrations. Maternal peripheral blood may also be submitted for parental chromosome analysis when there is recurrent pregnancy loss. The laboratory receives the specimen (amniotic fluid, chorionic villus sample, or peripheral blood), logs the sample, cultures cells if needed, performs metaphase preparation, counts five well-spread metaphase cells, and generates one banded karyotype image for interpretation. The typical site of service is an outpatient hospital laboratory or independent clinical cytogenetics laboratory. The clinical workflow includes order verification, specimen processing, cell culture (if required), chromosome banding, microscopic analysis by an analyst, karyotype photography, interpretation by a board-certified cytogeneticist, and report generation and transmission to the ordering provider.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the professional component (interpretation) of the cytogenetic study.
`TC`

Taxonomy Code	Specialty	Notes
2080P0800X	Medical Genetics	Clinical cytogeneticists and medical geneticists interpret karyotypes and provide consultative reports.
207Q00000X	Pathology	Cytogenetic testing is frequently performed under molecular pathology or clinical pathology departments.
363LP0800X	Laboratory Director	Clinical laboratory directors oversee testing quality, compliance, and result release.
207K00000X	Clinical Laboratory	Laboratory technologists and cytogenetic analysts perform sample processing and karyotyping.
207LP3000X	Molecular Genetic Pathology	Specialists performing cytogenetic and molecular diagnostic testing integration.

CPT Code	Description	Relationship to This Procedure
`88262`	Chromosome analysis; each additional cell counted (List separately in addition to code for primary study)	Used when more than five cells are counted; allows billing for extended cell counts beyond the initial `88261`.
`88271`	Microbial or eukaryotic in situ hybridization (e.g., FISH), per probe	Often performed alongside karyotype when targeted detection of specific chromosomal rearrangements or aneuploidy is needed for faster or higher-resolution results.
`88267`	Karyotype, other supplemental procedures (e.g., spectral karyotyping)	Used for advanced or supplemental chromosome visualization techniques when standard banding is insufficient.
`88270`	Chromosome analysis; by military or other specific techniques (legacy code)	Historical/alternate cytogenetic technique codes occasionally referenced in workflow; less commonly billed.
`88240`	Chromosome analysis, amniotic fluid; basic services (alternate code for prenatal cytogenetics)	Sometimes used in prenatal panels or related cytogenetic reporting workflows.

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