Summary & Overview
CPT 88291: Cytogenetic and Molecular Cytogenetic Interpretation and Report
CPT code 88291 denotes the professional interpretation and reporting of cytogenetic and molecular cytogenetic testing by a qualified provider, most often a pathologist. This code distinguishes the clinician’s interpretive work from the technical laboratory analysis performed by lab analysts and is central to claims that separately bill professional services for genetic and cytogenetic diagnostics. Nationally, the code matters as the volume of molecular and cytogenetic testing grows and as payers continue to define coverage policies and payment arrangements for interpretive services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of how CPT code 88291 is used in practice, including service definition, typical sites of service, and the clinical context for cytogenetic interpretation. The publication also summarizes commonly discussed reimbursement and coding considerations, benchmark comparisons across major payers, and recent policy updates affecting laboratory and pathology billing. Practical takeaways include when 88291 is reported separately from technical lab work, common billing contexts where the code appears, and areas where payers often issue guidance or edits.
Data not available in the input: associated taxonomies, ICD-10 diagnoses, related CPT or other codes, and payer-specific fee schedules.
Billing Code Overview
CPT code 88291 describes the interpretation and report by a qualified provider, typically a pathologist, of cytogenetic and molecular cytogenetic testing that is commonly performed by laboratory analysts. This code captures the professional interpretive component when a physician or other qualified clinician reviews cytogenetic findings and documents a formal diagnostic report.
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Service type: Professional interpretation and reporting of cytogenetic and molecular cytogenetic tests
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Typical site of service: Clinical laboratory or pathology department; interpretation may occur in hospital-based labs, independent diagnostic laboratories, or pathology practices where a pathologist or qualified provider reviews test results and issues a report.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with newly diagnosed acute myeloid leukemia (AML) undergoes bone marrow aspiration and cytogenetic testing. Laboratory analysts perform karyotype analysis and fluorescence in situ hybridization (FISH) for common recurrent translocations. A board-certified pathologist or clinical cytogeneticist reviews the test results, interprets chromosomal findings and molecular cytogenetic data, and issues the formal diagnostic report. The workflow includes specimen accessioning, analyst-performed testing (culture, harvest, staining, FISH probe hybridization), analyst technical documentation, and final review and interpretation by the qualified provider who signs out the cytogenetic/molecular cytogenetic report represented by 88291.
Typical site of service is an outpatient hospital laboratory, independent clinical laboratory, or hospital pathology department where cytogenetic and molecular cytogenetic testing is performed. The patient encounter commonly follows hematology/oncology consultation and is ordered to inform prognosis, risk stratification, and therapy selection.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the pathologist's interpretive report separate from the laboratory's technical component. |