CPT 88291 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 | 81 - Independent Laboratory 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | None XU - Unusual Non-Overlapping Service 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 88291 |
| Medicaid Fee Schedule | View Medicaid rates for 88291 |
National average reimbursement for CPT 88291 by major payers:
$38.01
$27.31
$39.99
$33.68
CPT 88291 vs. Other Cytogenetic Studies Codes
The CPT 88291 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 88291 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 |
|---|---|---|
| 88285-CPT | Low | Additional Cell Count In Study, Additional Cells Counted Beyond The Base Chromosome Analysis. The Study Uses Traditional Microscopic Techniques To Check For Genetic Anomalies And Recessive Traits. Additional Cell Counts May Be Necessary To Pinpoint A Diagnosis For Certain Cancers. |
| 88289-CPT | Low | Study For Inherited Condition, The Study Analyzes Chromosomes To Find Out If They Contain Any Genetic Traits Associated With Inherited Conditions. The Study Involves Several High-Resolution Examinations. |
| 88291-CPT | Low | Cytogentic & Molecular Cytogentic Interpret & Rport, Cytogenetics And Molecular Cytogenetics Interpretation And Report |
| 88350-CPT | Low | Immune Study Tissue Sample, For This Study Antibodies From A Tissue Sample Are Treated With Fluorescent Dye And Then Examined Under A Microscope. Intensity Pattern And Distribution Of The Antibodies Aid Diagnosis. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 88291. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 88291 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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