Highmark Medicare Advantage Medical Policy in West Virginia
Section: CMS National Guidelines
Number: N-147
Topic: Cytogenetic Studies – NCD 190.3
Effective Date: May 4, 2009
Issued Date: May 4, 2009

General Policy

Cytogenetic studies are used to describe the microscopic examination of the physical appearance of human chromosomes.

Indications and Limitations of Coverage

Cytogenetic studies are covered when they are reasonable and necessary for the diagnosis or treatment of the following conditions:

NOTE:
This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Procedure Codes

882308823388235882378823988240
882418824588248882498826188262
88263 88264 88267 88269 88271 88272
88273 88274 88275 88280 88283 88285
88289 88291 88299   

Coding Guidelines

Publications

References

Title XVIII of the Social Security Act, Section 1862(a)(7). This section excludes routine physical examinations.

Title XVIII of the Social Security Act, Section 1862(a)(1)(A). This section states that no payment shall be made for items or services that are not reasonable and necessary for the diagnosis or treatment of illness or injury.

Title XVIII of the Social Security Act, Section 1833(e). This section prohibits payment for any claim that lacks the necessary information to process the claim.

On-Line Manual 100-03, Chapter 1, Section 190.3

www.cms.gov
www.medicare.gov

Attachments

Procedure Code Attachments

Diagnosis Codes

The list of diagnosis codes below is not all inclusive.

200.00 - 200.88201.00 - 201.98202.00 - 202.98203.00 - 203.82
204.00 - 204.92205.00 - 205.92206.00 - 206.92207.00 - 207.82
208.00 - 208.92238.72 - 238.75259.0 655.10 - 655.13
742.59 758.0-758.9  

Glossary




This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Medical policies are designed to supplement the terms of a member's contract. The member's contract defines the benefits available; therefore, medical policies should not be construed as overriding specific contract language. In the event of conflict, the contract shall govern.

Medical policies do not constitute medical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines for coverage and reimbursement under Medicare Advantage plans. Application of a medical policy to determine coverage in an individual instance is not intended and shall not be construed to supercede the professional judgment of a treating provider. In all situations, the treating provider must use his/her professional judgment to provide care he/she believes to be in the best interest of the patient, and the provider and patient remain responsible for all treatment decisions.

Medicare Advantage retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of Medicare Advantage. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.