About this policy
Jurisdiction: J15 MAC Part B. States: Kentucky, Ohio. Type: Active LCD
Coverage indications
This policy provides coverage for indicated fluorescent in situ hybridization (FISH) probes for patients whose bone marrow examination is suggestive of myelodysplasia (MDS) and who have an inadequate cytogenetic assessment by conventional karyotyping. In general, conventional karyotype analysis is sufficient for confirmation for the diagnosis of MDS. MDS FISH studies should only be performed when there are fewer than 20 metaphases available for analysis, or an unresolved karyotype. Medicare will only cover up to 4 FISH studies (-7 or del(7q), -5 or del(5q), +8 and del(20q) on initial evaluation to diagnose MDS. Reflex testing for additional FISH markers to diagnose MDS is only reasonable and necessary when the initial 4 studies are negative or the diagnosis remains uncertain following the initial 4 probes. Generally, FISH testing is not reasonable and necessary for MDS and provides little if any additional information to conventional karyotyping.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
| Code | Code system | Status in this policy |
|---|---|---|
| 88271 | CPT | Covered |
| 88273 | CPT | Covered |
| 88274 | CPT | Covered |
| 88275 | CPT | Covered |
| 88291 | CPT | Covered |
| C94.6 | ICD10CM | Covered |
| D46.0 | ICD10CM | Covered |
| D46.1 | ICD10CM | Covered |
| D46.20 | ICD10CM | Covered |
| D46.21 | ICD10CM | Covered |
| D46.22 | ICD10CM | Covered |
| D46.A | ICD10CM | Covered |