CPT 88267 Prenatal Karyotype Reimbursement | OpenPayer

Summary & Overview

CPT 88267: Prenatal Chromosome Analysis (Karyotype)

CPT code 88267 identifies a prenatal cytogenetic procedure: chromosome analysis (karyotype) on cells from amniotic fluid or chorionic villus, with counting of 15 cells and preparation of one banded karyotype. This testing is a key diagnostic tool in prenatal care to detect aneuploidies and large chromosomal rearrangements that can impact pregnancy management and counseling. Nationally, prenatal cytogenetic testing remains a relevant component of maternal-fetal services due to ongoing prenatal screening programs and referrals from obstetric providers.

Key payers considered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The content summarizes clinical context, typical sites of service (hospital or specialized clinical laboratories), and what readers can expect from the full publication: benchmark billing and utilization context, coding and clinical scope, and policy or reimbursement considerations affecting access to prenatal cytogenetic services. Where payer-specific coverage patterns or edits exist, those are summarized in the detailed sections of the publication. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare88267CPTcytogeneticsprenatal-testingkaryotypeamniocentesischorionic-villus-samplingclinical-laboratory

Billing Code Overview

CPT code 88267 describes a chromosome analysis (karyotype) performed on cells from amniotic fluid or chorionic villus, in which the analyst counts 15 cells and prepares one banded karyotype. This procedure is a prenatal cytogenetic test used to evaluate fetal chromosomes for numeric or large structural abnormalities.

Service type: Cytogenetic analysis (prenatal karyotyping)
Typical site of service: Hospital clinical laboratory or specialized cytogenetics laboratory associated with obstetric or maternal-fetal medicine services

Clinical & Coding Specifications

Clinical Context

A 32-year-old pregnant patient at 16 weeks' gestation presents for prenatal diagnostic testing after a positive noninvasive prenatal screening (NIPS) indicating an increased risk for aneuploidy. The obstetrics team performs an amniocentesis to obtain amniotic fluid. The specimen is sent to the cytogenetics laboratory. A cytogenetic analyst cultures fetal cells from the amniotic fluid, performs chromosome analysis with banding, counts 15 metaphase cells, and prepares one diagnostic karyotype. The laboratory report documents chromosomal number and structure, and the result is communicated to the referring maternal-fetal medicine specialist. The typical workflow includes specimen accessioning, cell culture, harvest and slide preparation, G-banding, microscopic analysis, karyotype preparation, result verification, and release to the electronic medical record and ordering clinician.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the professional interpretation component if the lab separates technical and professional charges.
`TC`	Technical component	Use when billing only the technical component (laboratory processing and cytogenetic preparation) without professional interpretation.

CPT 88289: Additional High-Resolution Chromosome Analysis

CPT-88233-TISSUE-CULTURE-SKIN-SOLID-TISSUE-NONNEOPLASTIC

CPT 88233: Tissue Culture from Skin or Solid Tissue Biopsy for Nonneoplastic Disorder

CPT-88235-AMNIOTIC-FLUID-CHORIONIC-VILLUS-TISSUE-CULTURE

CPT 88235: Amniotic Fluid or Chorionic Villus Tissue Culture for Chromosome Analysis

CPT-88239-SOLID-TUMOR-CELL-CULTURE-NEOPLASTIC-DISORDER

CPT 88239: Cell Culture From Solid Tumor for Neoplastic Disorder

CPT-88275-INTERPHASE-FISH-100-300-CELL-ANALYSIS

CPT 88275: Interphase FISH Analysis, 100–300 Cells

CPT-88269-AMNIOTIC-FLUID-CELL-CHROMOSOME-ANALYSIS-KARYOTYPE

CPT 88269: In Situ Chromosome Analysis of Cultured Amniotic Fluid Cells

CPT-88237-BONE-MARROW-BLOOD-CELL-CULTURE-NEOPLASTIC-DISORDER

CPT 88237: Cell Culture for Bone Marrow or Blood in Neoplastic Disorder

CPT-88299-UNLISTED-CYTOGENETIC-PROCEDURE

CPT 88299: Unlisted Cytogenetic Procedure

CPT-88274-INTERPHASE-FISH-25-99-CELLS-MOLECULAR-CYTOGENETIC-TEST

CPT 88274: Interphase FISH, Analysis of 25–99 Cells

CPT-88285-CYTOGENETIC-CELL-COUNTING-FOLLOW-UP-CHROMOSOME-ANALYSIS

CPT 88285: Analyst Chromosome Analysis with Additional Cell Counting

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Taxonomy Code	Specialty	Notes
207RH0000X	Reproductive Endocrinology/Infertility	Maternal-fetal medicine and reproductive specialists ordering prenatal diagnostic testing.
207VM1200X	Maternal-Fetal Medicine	Specialists managing high-risk pregnancies who order amniocentesis and interpret results.
2080N0005X	Clinical Cytogenetics	Laboratory directors and cytogeneticists performing karyotype analysis.
207L00000X	Obstetrics & Gynecology	OB providers who coordinate specimen collection and counseling.
2080S0004X	Clinical Laboratory	Laboratory directors and technologists responsible for technical processing and reporting.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`O28.3`	Abnormal findings on antenatal screening of mother, unspecified	Positive prenatal screening (e.g., abnormal maternal serum or NIPS) prompting diagnostic amniocentesis and karyotype.
`Z36`	Encounter for antenatal screening of mother	Routine or targeted prenatal screening visit where diagnostic testing may be ordered.
`O35.0XX0`	Maternal care for (suspected) chromosomal abnormality in fetus, unspecified trimester, not applicable or unspecified	Direct indication for fetal chromosome analysis by amniocentesis or chorionic villus sampling.
`Z33.1`	Pregnant state, incidental	Pregnancy indicator often present on the claim to confirm pregnancy-related testing.
`R87.619`	Abnormal cytology of other specified sites	If preliminary cytogenetic or cytology results from chorionic villus sampling suggest abnormality, full karyotype may follow.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`59015`	Amniocentesis, needle or trocar, guidance with ultrasound when performed	Performed before `88267` to obtain amniotic fluid specimen for cytogenetic analysis.
`88271`	Chromosome analysis, bone marrow; analysis and report, banded studies, metaphase count and karyotype (peripheral blood/bone marrow)	Alternative chromosome analysis code used for other specimen types; related laboratory methodology.
`88262`	Chromosome analysis, karyotype, peripheral blood, prenatal testing not otherwise specified (example code for related technical procedures)	Represents other cytogenetic analyses that may be ordered alongside or instead of amniotic fluid karyotype.
`88384`	Immunohistochemistry, per single antigen; initial single antibody stain	Occasionally performed on chorionic villus tissue if additional tissue-based studies are needed in conjunction with karyotyping.
`88275`	Fluorescence in situ hybridization (FISH) for aneuploidy; multiple probes	Often performed as a rapid adjunct test for targeted aneuploidy detection while awaiting full karyotype from `88267`.

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