CurrentHumanaPolicy LAB2023032

Laboratory Epithelial Cell Cytology in Breast Cancer Risk Assessment

This Medicare Advantage payment policy explains Humana's claims payment stance on cytologic analysis of epithelial cells for breast cancer risk assessment and applies to Medicare Advantage members and providers submitting related claims.

Policy Summary

PayerHumana

PolicyLaboratory Epithelial Cell Cytology in Breast Cancer Risk Assessment

Policy CodePolicy LAB2023032

Change TypeNo material change

Effective Date06/2023

Next Review Date

Key ActionCytologic analysis of epithelial cells (CPT codes 88108, 88112) in the evaluation or management of breast cancer is not reimbursable for Medicare Advantage plans.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2codes listed as not reimbursable

Medicare Advantageapplicability

06/2023original publish date

07/2025most recent revision date

Coverage Position

Non-reimbursement for breast epithelial cell cytology

Humana Medicare Advantage payment policy position on cytologic epithelial cell analysis in breast cancer evaluation:

Non-reimbursement statement: Cytologic analysis of epithelial cells (CPT codes 88108, 88112) in the evaluation or management of breast cancer is not reimbursable for Medicare Advantage plans.

Relevant Codes

Breast epithelial cell cytology codesCPTNot Covered

88108	Cytopathology, concentration technique, smears and interpretation (e.g., Saccomanno technique)
88112	Cytopathology, selective cellular enhancement technique with interpretation (e.g., liquid-based slide preparation method) except cervical or vaginal

Provider Billing and Authorization Guidance

Policy Summary

PayerHumana

PolicyLaboratory Epithelial Cell Cytology in Breast Cancer Risk Assessment

Policy CodePolicy LAB2023032

Change TypeNo material change

Effective Date06/2023

Next Review Date

Key ActionCytologic analysis of epithelial cells (CPT codes 88108, 88112) in the evaluation or management of breast cancer is not reimbursable for Medicare Advantage plans.

SourceLink

On This Page

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Billing Rule

Do not bill CPT 88108 or 88112 for breast cancer evaluation — not reimbursable

Cytologic analysis of epithelial cells (CPT codes 88108 and 88112) when performed for the evaluation or management of breast cancer is not reimbursable for Humana Medicare Advantage plans. Providers should not submit claims for these services for Medicare Advantage members, as they will not be paid under this policy.

Do not bill CPT 88108 or 88112 for evaluation or management of breast cancer for Medicare Advantage members — these services are not reimbursable.
Claims remain subject to other plan requirements (medical necessity, reasonableness, referral/authorization) and may be denied if submitted.

Definitions

Cytologic analysis (codes 88108, 88112)

DefinitionCytologic analysis of epithelial cells (CPT 88108, 88112): laboratory examination of epithelial cell samples using cytopathology concentration or selective cellular enhancement techniques to prepare and interpret smears or slides.

CPT 88108Cytopathology — concentration technique, smears and interpretation (e.g., Saccomanno technique).

CPT 88112Cytopathology — selective cellular enhancement technique with interpretation (e.g., liquid-based slide preparation) except cervical or vaginal specimens.

Coverage stance (most actionable)Not reimbursable for evaluation or management of breast cancer for Medicare Advantage plans.

ApplicabilityHumana Medicare Advantage members and providers submitting related claims.