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Unit Code 80027:
B-Cell Lymphoma, FISH, Tissue

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List Fee

$499.40

 

(When chromosome analysis procedure is performed, it is

charged separately.) 

 

The following test(s) will be added at an additional charge:

$72.00 for #8874 "Pathology Consultation, Limited Without Review of

Patient's Medical Record"

 

$548.50 = Total List Fee

 

One of the following tests may be added per the testing algorithm:

$50.00 for #80024 "One Additional FISH Probe"

$75.00 for #80025 "Two Additional FISH Probes"

$100.00 for #87825"Three Additional FISH Probes"

$125.00 for #80026 "Four Additional FISH Probes"

$150.00 for #87826 "Five Additional FISH Probes"

$175.00 for #87827 "Six Additional FISH Probes"

$200.00 for #87828 "Seven Additional FISH Probes"

$225.00 for #87829 "Eight Additional FISH Probes"

$250.00 for #87830 "Nine Additional FISH Probes"

$275.00 for #87831 "Ten Additional FISH Probes"

$300.00 for #87832 "Eleven Additional FISH Probes"

$325.00 for #87833 "Twelve Additional FISH Probes"

Test Classification

Analyte Specific Reagent
This test was developed and its performance characteristics

determined by Laboratory Medicine and Pathology, Mayo Clinic.

This test has not been cleared or approved by the U.S. Food

and Drug Administration.

CPT Code Information

"B-Cell Lymphoma, FISH, Tissue"

88271/x2DNA probe, each

88275/Interphase in situ hybridization, 100-300 cells

88291/Interpretation and report

 

"Pathology Consultation, Limited w/o Review of Patients Medical

Record"

80500

 

 "One Additional FISH Probe"

88271/DNA probe, each (if appropriate)

88275/Interphase in situ hybridization (if appropriate)

 

 "Two Additional FISH Probes"

88271/x2 DNA probe, each (if appropriate)

88275/Interphase in situ hybridization (if appropriate)

 

"Three Additional FISH Probes"

88271/x3 DNA probe, each (if appropriate)

88275/Interphase in situ hybridization (if appropriate)

 

"Four Additional FISH Probes"

88271/x4 DNA probe, each (if appropriate)

88275/x2 Interphase in situ hybridization (if appropriate)

 

"Five Additional FISH Probes"

88271/x5 DNA probe, each (if appropriate)

88275/x2 Interphase in situ hybridization (if appropriate)

 

"Six Additional FISH Probes"

88271/x6 DNA probe, each (if appropriate)

88275/x3 Interphase in situ hybridization (if appropriate)

 

"Seven Additional FISH Probes"

88271/x7 DNA probe, each (if appropriate)

88275/x3 Interphase in situ hybridization (if appropriate)

 

"Eight Additional FISH Probes"

88271/x8 DNA probe, each (if appropriate)

88275/x4 Interphase in situ hybridization (if appropriate)

 

"Nine Additional FISH Probes"

88271/x9 DNA probe, each (if appropriate)

88275/x4 Interphase in situ hybridization (if appropriate)

 

"Ten Additional FISH Probes"

88271/x10 DNA probe, each (if appropriate)

88275/x5 Interphase in situ hybridization (if appropriate)

 

"Eleven Additional FISH Probes"

88271/x11 DNA probe, each (if appropriate)

88275/x5 Interphase in situ hybridization (if appropriate)

 

"Twelve Additional FISH Probes"

88271/x12 DNA probe, each (if appropriate)

88275/x6 Interphase in situ hybridization (if appropriate)

Key