Summary & Overview
CPT 88262: Chromosome Analysis (Banded Karyotype)
CPT code 88262 represents a cytogenetic chromosome analysis (karyotype) in which an analyst evaluates chromosomal structure and number by counting 15–20 cells and creating two banded karyotypes. This test is a core diagnostic tool for identifying numeric and structural chromosomal abnormalities relevant to prenatal diagnosis, congenital anomalies, infertility, hematologic malignancies, and other genetic conditions, making it important across clinical specialties and payers nationally.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for 88262, typical sites of service, and the types of benchmarks and policy considerations commonly associated with cytogenetic testing coverage. The publication outlines reimbursement and billing considerations, common modifiers, and how coverage policies and medical necessity criteria can affect ordering and claims processing. The content also summarizes typical utilization patterns, coding relationships, and areas where payer-specific policy differences often arise.
This resource is intended to inform clinicians, laboratory managers, and billing professionals about the clinical role of CPT code 88262, the payer landscape, and the key items to review when preparing claims or evaluating coverage policies.
Billing Code Overview
CPT code 88262 describes a chromosome analysis (karyotype) performed by a laboratory analyst. The test examines a person’s genetic material for chromosomal abnormalities by counting 15 to 20 cells and producing two banded karyotypes (photographic representations of the chromosomes).
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Service type: Cytogenetic analysis / chromosome analysis
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Typical site of service: Clinical diagnostic laboratory or hospital laboratory setting
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or pediatric individual referred for cytogenetic analysis to evaluate suspected chromosomal abnormalities. Common clinical presentations include: multiple congenital anomalies, developmental delay or intellectual disability, recurrent pregnancy loss, abnormal prenatal screening, infertility with suspected chromosomal translocation, or hematologic malignancy requiring karyotype for diagnosis and prognostic information. The clinical workflow begins with a clinician order for chromosome analysis (88262). A specimen (blood, bone marrow, or tissue) is collected and sent to the cytogenetics laboratory. The laboratory analyst cultures cells, arrests them in metaphase, prepares slides with banding, examines and counts 15–20 metaphase cells, and creates two karyotypes. Results are reviewed by a cytogeneticist, documented in the report, and routed to the ordering provider for clinical interpretation and follow-up testing if abnormalities are detected. Typical site of service is an outpatient cytogenetics laboratory or hospital pathology/laboratory department; prenatal specimens may originate from an obstetrics clinic or maternal-fetal medicine unit.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation component separate from the technical lab component. |