Summary & Overview

CPT 88272: FISH Molecular Cytogenetic Test, 3–5 Cells

CPT code 88272 covers a targeted molecular cytogenetic assay using chromosomal in situ hybridization, most often fluorescence in situ hybridization (FISH), to evaluate three to five cells for chromosomal derivatives and marker chromosomes. This test is clinically important for prenatal and hematologic genetic evaluation, enabling detection of specific rearrangements and additional genetic material that influence diagnosis, prognosis, and care planning. Nationally, such assays are integral to genetic diagnostics in obstetrics and clinical pathology laboratories.

Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides an overview of coverage and reimbursement benchmarks, clinical context for when the assay is used (for example, amniotic fluid and blood specimens), and policy considerations influencing laboratory billing and documentation. Readers will find concise benchmarks of coverage practice, common site-of-service considerations, and a clear clinical description of the assay's role. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare88272CPTmolecular-cytogeneticsFISHchromosomal-in-situ-hybridizationprenatal-diagnosticslaboratory-servicesclinical-pathology

Billing Code Overview

CPT code 88272 describes a molecular cytogenetic test performed using chromosomal in situ hybridization methods, typically fluorescence in situ hybridization (FISH), to analyze three to five cells for chromosomal abnormalities such as derivatives and marker chromosomes. The procedure is commonly applied to specimens like amniotic fluid or blood to detect specific genetic rearrangements and additions of genetic material.

Service Type: Molecular cytogenetic testing (chromosomal in situ hybridization / FISH)

Typical Site of Service: Clinical laboratory or hospital laboratory

Clinical & Coding Specifications

Clinical Context

A 32-year-old pregnant patient at 18 weeks gestation is referred to a maternal-fetal medicine laboratory after an abnormal prenatal screening (increased nuchal translucency and abnormal cell-free DNA result) indicating possible chromosomal rearrangement. Amniocentesis is performed and amniotic fluid is submitted to the cytogenetics laboratory. The laboratory analyst performs a molecular cytogenetic test using fluorescence in situ hybridization to analyze three to five fetal cells for specific chromosomal abnormalities, such as marker chromosomes, derivative chromosomes, or microdeletions/duplications suggested by prior screening. Results are interpreted by a board-certified clinical cytogeneticist and reported to the referring obstetrician and genetic counselor. Typical workflow steps: specimen receipt and accessioning, cell preparation and fixation, hybridization with locus-specific or chromosome-specific probes, microscopic analysis of three to five cells, photographic documentation, result interpretation, and a written report uploaded to the electronic medical record. Typical site of service is an outpatient cytogenetics laboratory within a hospital or reference laboratory processing specimens from amniotic fluid or peripheral blood.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the professional (interpretation) portion by the laboratory professional.
`TC`	Technical component	Use when billing only the technical component (laboratory testing, equipment, materials).
`90`	Reference (outside) laboratory	Use when the service is performed by an outside laboratory and billed through another provider.
`59`	Distinct procedural service	Use when this test is distinct from another service on the same day (e.g., separate FISH probe sets).
`62`	Two surgeons (analogous for dual practitioners)	Rarely used; applicable if two qualified laboratory physicians share reporting responsibility per payer policy.
`82`	Assistant at surgery — unplanned	Use in unusual cases where an additional qualified professional assists in the procedure or interpretation unexpectedly.
`52`	Reduced service	Use when the test was partially completed or limited (e.g., insufficient cells for full probe set).
`53`	Discontinued procedure	Use when testing is started but discontinued and documentation supports termination for patient safety or specimen issues.
`77`	Repeat procedure by another physician	Related conceptually when another laboratory repeats testing for verification; note `77` is not in the provided list so not used.
`90`	Duplicate entry removed	(Duplicate removed; only included once above.)

Taxonomy Code	Specialty	Notes
`207RH0000X`	Clinical Cytogenetics Laboratory	Laboratory specialty performing molecular cytogenetic testing.
`2085P0207X`	Maternal-Fetal Medicine	Referring specialty ordering prenatal FISH testing.
`208000000X`	Obstetrics & Gynecology	Common ordering provider for prenatal genetic testing.
`207K00000X`	Pathology-Anatomic & Clinical	Pathologists or laboratory directors overseeing cytogenetics.
`208D00000X`	Medical Genetics	Clinical geneticists or genetic counselors involved in interpretation and counseling.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`O35.0XX0`	Maternal care for (suspected) chromosomal abnormality in fetus, unspecified trimester, not applicable or unspecified	Used when prenatal testing is ordered because of suspected fetal chromosomal abnormality.
`O36.5XX0`	Maternal care for other fetal problems, unspecified trimester, not applicable or unspecified	Applied when specific fetal anomalies on ultrasound prompt targeted FISH testing.
`Z36`	Encounter for antenatal screening of mother	Indicates antenatal screening context leading to diagnostic FISH testing.
`R92.8`	Other abnormal and inconclusive findings on diagnostic imaging of breast — (used here analogously for abnormal imaging findings prompting testing)	In prenatal context, abnormal ultrasound findings (use specific fetal anomaly codes when present).
`Z31.5`	Encounter for infertility testing and counseling	Peripheral blood FISH may be used in certain reproductive genetics evaluations.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`88271`	Chromosome analysis, constitution (eg, karyotype), peripheral blood, amniotic fluid, bone marrow, or chorionic villi; cell culture and full karyotype analysis	Often performed before or alongside FISH to assess whole-chromosome structure and detect balanced rearrangements.
`88275`	In situ hybridization (eg, FISH), each probe, except amplification probe; probe set for enumeration (per probe set)	Used to report additional probe sets when more than one distinct FISH probe set is analyzed in the same specimen.
`88381`	Visual examination and report of cytogenetic studies (microscopic, karyotype, FISH)	May be used for professional interpretation and reporting, depending on payer coding practices.
`88267`	Molecular cytogenetics; in situ hybridization for microdissection or other specialized analysis	Used for specialized molecular cytogenetic techniques that complement routine FISH, when indicated.
`88274`	In situ hybridization (eg, FISH), each probe; probe set for localization	Related when localization probe sets are applied to detect structural rearrangements in specific regions.