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
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
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