CPT 88291Laboratory

Cyto/molecular report

CPT 88291 covers the professional work of interpreting and reporting results from cytogenomic (chromosome and molecular) laboratory tests. This is the physician's analysis and written report, not the actual laboratory test itself.

Showing rates for

National Average

Base Medicare rate

$32.99

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.52

PE RVU (NF)

0.48

MP RVU

0.02

Total RVU

1.02

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Bill 88291 separately from the technical cytogenomic procedure codes (such as 81228, 81229, 81349, or 88271-88275) to capture the physician interpretation component
Impact: Ensures capture of the full $32.99 Medicare payment for professional interpretation that would otherwise be lost
Document the specific clinical information reviewed, analytical methodology assessed, and clinical correlation performed in the written report to support medical necessity
Impact: Reduces denial risk by 40-60% and supports payment during audits
Verify that the ordering physician has documented medical necessity for the genetic test with appropriate diagnosis codes reflecting the clinical indication
Impact: Prevents denials for lack of medical necessity which account for approximately 30% of genetic testing claim denials
Do not bill 88291 for automated or computer-generated reports without substantial physician interpretation and correlation
Impact: Avoids fraud and abuse allegations; OIG specifically scrutinizes interpretation codes billed without actual physician cognitive work
Ensure the interpreting physician's NPI and credentials are clearly documented and match the billing provider information
Impact: Prevents provider credentialing denials that can delay payment 30-90 days
Check payer-specific policies for cytogenomic testing coverage as many commercial payers require prior authorization for both the technical and professional components
Impact: Prior authorization compliance can prevent 100% payment denial on claims averaging $500-2000 for complete cytogenomic testing panels

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Frequently asked questions

What is CPT code 88291 used for?

CPT 88291 is used to bill for the physician's professional interpretation and written report of cytogenomic constitutional (germline) laboratory testing. This includes the analysis and correlation of molecular and chromosomal findings with patient clinical information, separate from the technical performance of the laboratory test itself.

How much does Medicare pay for CPT 88291 in 2025?

Medicare pays $32.99 for CPT 88291 in 2025 based on the national average non-facility rate. The total RVU is 1.02, consisting of 0.52 work RVU, 0.48 practice expense RVU, and 0.02 malpractice RVU, multiplied by the 2025 conversion factor of 32.3465.

Can CPT 88291 be billed with other cytogenetic codes?

Yes, CPT 88291 is typically billed in addition to the technical cytogenomic procedure codes such as 81228, 81229, 81349, 88271, 88272, 88273, 88274, or 88275. The 88291 code represents only the physician interpretation component, while other codes represent the technical laboratory performance of the test.

Who can bill CPT code 88291?

CPT 88291 can be billed by physicians with expertise in cytogenetics or molecular genetics, typically board-certified in Clinical Cytogenetics, Medical Genetics, Clinical Pathology, or Molecular Genetic Pathology. The interpreting physician must be appropriately credentialed and licensed, and the laboratory must be CLIA-certified for high-complexity testing.

What documentation is required to bill 88291?

Documentation must include a signed and dated physician interpretation report that demonstrates clinical correlation, detailed findings, diagnostic impression, and recommendations. The report must show the physician reviewed the technical data, correlated findings with clinical information, and provided expert interpretation beyond automated or computer-generated results.

Is prior authorization required for CPT 88291?

Prior authorization requirements vary by payer. While Medicare typically does not require prior authorization for 88291 specifically, many commercial payers require prior authorization for genetic testing panels that include both the technical and professional interpretation components. Always verify payer-specific policies before performing the service.

What is the difference between 88291 and technical cytogenetic codes?

CPT 88291 represents only the physician's cognitive work in interpreting and reporting cytogenomic test results, while technical codes (such as 88271-88275 or molecular codes 81228-81349) represent the actual laboratory performance of the test. Both components are separately billable - the technical component by the laboratory and the professional component (88291) by the interpreting physician.