CPT 88272 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Cytogenetic Studies |
| Common Place of Service | 11 - Office 81 - Independent Laboratory |
| Common Modifiers | None 59 - Distinct Procedural Service GC - Service performed by resident under supervision |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 88272 |
| Medicaid Fee Schedule | View Medicaid rates for 88272 |
National average reimbursement for CPT 88272 by major payers:
$37.26
$36.92
$38.70
$56.99
CPT 88272 vs. Other Cytogenetic Studies Codes
The CPT 88272 code is part of the Pathology and Laboratory Procedures services used for Cytogenetic Studies. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 88272 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 88272-CPT | Low | Chromosome Genetic Study, The Test Uses A Fluorescent Stain To Detect Dna Sequence In Cells. Dna Sequence Determines An Individuals Genetic Makeup. |
| 88273-CPT | Low | Molecular Cytogenetics Chromo, Molecular Cytogenetics Chromosomal In Situ Hybridizationanalyze 10-30 Cells (Eg For Microdeletions) Molecular Cytogenetics Chromosomal In Situ Hybridization |
| 88274-CPT | Low | Genetic Analysis Of Cells, This Study Uses A Technique That Separates And Recombines A Dna Strand Directly On A Viewing Slide. The Technique Analyzes How A Genetic Alteration Affects The Number Of Genes In A Specified Number Of Cells. |
| 88275-CPT | Low | Genetic Analysis Of Cells, This Study Uses A Technique That Separates And Recombines A Dna Strand Directly On A Viewing Slide. The Technique Analyzes How A Genetic Alteration Affects The Number Of Genes In A Specified Number Of Cells. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 88272. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 88272 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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