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Medicare & Medical Necessity

 

Medicare has stated that they will cover Chromosome/FISH analysis when it is reasonable and necessary for the diagnosis and treatment of the following diagnoses listed below. For any other diagnosis Medicare will declare cytogenetic studies to be not medically necessary. We ask that when a provider feels that cytogenetic testing is required please verify that the patient’s diagnosis is listed among the approved ICD-9 codes. If the diagnosis is not listed, please present an Advance Beneficiary Notice to the patient. Your staff will need to inform the patient of the cost of the lab tests so they may decide if they want to pay out of pocket. Currently Medicare is not covering DNA testing, this includes sequencing and molecular services.

If you have any questions or concerns feel free to contact our staff at 405-271-3589 and we will be happy to help.

ICD-10 Codes that Support Medical Necessity for Chromosome and/or FISH analysis for Medicare:

C91.00--C91.02 Acute lymphoid leukemia

C92.00--C92.A2 Acute myeloid leukemia

C91.10--C91.12 Chronic lymphoid leukemia

C92.10--C92.12 Chronic myeloid leukemia

D46.0--D46.B Low grade myelodysplastic syndrome lesions

D46.22--High grade myelodysplastic syndrome lesions

D46.C--Myelodysplastic syndrome with 5q deletion

D46.9--D46.Z Myelodysplastic syndrome unspecified

O01.0--O01.9 Hydatidiform mole

O02.81-- Other abnormal product of conception

O02.1--Missed abortion

O26.21--O26.23 Habitual aborter, antepartum condition or complication

O35.1XX0--O35.1XX9 Chromosomal abnormality in fetus; unspecified as to episode of care or not applicable

O36.4XX0--O36.4XX9 Intrauterine death; unspecified as to episode of care or not applicable

Q90.0--Q99.9 Chromosomal abnormalities

 

 

Contact Information
Genetics Laboratory
University of Oklahoma Health Sciences Center
1122 NE 13 Street, Suite 1400, Oklahoma City, OK 73104
Phone: (405) 271-3589 |Fax: (405) 271-7117 Email: Dr. Shibo Li

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