Is 88342 covered by Medicare?

Effective 6/12/2015, 88342 was reactivated by CMS for Medicare submission. CPT® 88343 was deleted 01/01/2015. HCPCS codes G0461 and G0462 were deleted 1/1/2015.”

Can 88341 and 88342 be billed together?

NOTE that CPT 88341 has a + sign denoting it is an add on code and can only be billed when CPT 88342 is also billed.

What is the difference between 88341 and 88342?

Code 88342 should be used for the first single antibody procedure and is reimbursed as one unit only. Code 88341 should be used for each additional single antibody for each specimen, and is reimbursed up to a maximum of 9 units.

How does antibody staining work?

Immunohistochemical staining is accomplished with antibodies that recognize the target antigen. Since antibodies are highly specific, the antibody will bind only to the antigen of interest in the tissue section. The antibody-antigen interaction is then visualized using different detection systems.

Does Medicare pay for molecular testing?

Medicare has limited coverage of genetic testing for an inherited genetic mutation. Medicare covers genetic testing for people with a cancer diagnosis who meet certain criteria; you must have a cancer diagnosis to qualify for coverage of genetic testing for an inherited mutation under Medicare.

Is CPT 81291 covered by Medicare?

MTHFR (methyltetrahydrofolate reductase) gene testing (81291) is non-covered for HMO, PPO, Individual Marketplace, & Elite/ProMedica Medicare Plan. Genetic testing for hereditary thrombophilia (81240, 81241, 81291) requires prior authorization for Advantage.

Does 88342 need a modifier?

Modifier 59 may be reported with CPT code *88342 if each procedure is for a different antibody. For example: A needle biopsy is performed on the left breast and an immunohistochemistry antibody stain procedure is performed using GATA3 and a morphometric analysis antibody stain procedure is performed using HER2.

What is Multiplex Immunohistochemistry?

Multiplex Immunohistochemistry/Immunofluorescence (mIHC/IF) technologies, which allow the simultaneous detection of multiple markers on a single tissue section, have been introduced and adopted in both research and clinical settings in response to increased demand for improved techniques.

Why are antibodies used in staining?

In immunostaining methods, an antibody is used to detect a specific protein epitope. These antibodies can be monoclonal or polyclonal. Detection of this first or primary antibody can be accomplished in multiple ways. The primary antibody can be directly labeled using an enzyme or fluorophore.

What does 88341 stand for?

88341 IMMUNOHISTOCHEMISTRY OR IMMUNOCYTOCHEMISTRY, PER SPECIMEN; EACH ADDITIONAL SINGLE ANTIBODY STAIN PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 88342 IMMUNOHISTOCHEMISTRY OR IMMUNOCYTOCHEMISTRY, PER SPECIMEN; INITIAL SINGLE ANTIBODY STAIN PROCEDURE

Is 88342 being done for cytogenetic analysis?

LCD L30538 – Cytogenetic Analysis, and our 88342 are not being done for cytogenetic analysis but this doesn’t seem to matter at all. We had to file over 40 appeals in the last week.

What is the Centers for Medicare&Medicaid Services (CMS)?

The Centers for Medicare & Medicaid Services (CMS), the federal agency responsible for administration of the Medicare, Medicaid and the State Children’s Health Insurance Programs, contracts with certain organizations to assist in the administration of the Medicare program.

Are chemosensitivity profile tumor panels covered by Medicare?

Chemosensitivity profile tumor panels, regardless of whether it is performed by IHC or chromogenic in-situ hybridization (CISH), is not reasonable and necessary for the reasons cited above, and is not a Medicare covered service.