Reimbursement for epithelial cell cytology procedure codes
This policy governs UnitedHealthcare Medicare Advantage reimbursement for certain epithelial cell cytology procedure codes related to breast cancer risk assessment; it affects providers billing CMS 1500 or UB04 for Medicare Advantage members.
New Policy
Policy Language update in Reimbursement Guidelines section
Coverage Determination
Non-reimbursable procedure codes for breast cancer risk assessment
UnitedHealthcare will not consider reimbursement for the following epithelial cell cytology procedure codes when used for breast cancer risk assessment and management.
ALL of the following
List of non-reimbursable procedure codes
- CPT 88108 — Cytopathology, cervical or vaginal; single cell, automated or manual screening
- CPT 88112 — Cytopathology, cervical or vaginal; by technician, screening only
- CPT 88172 — Cytopathology, other source; smear, initial interpretation
- CPT 88173 — Cytopathology, other source; smear, rescreening or subsequent interpretation
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