CMSNational Coverage Determination (NCD)

Cytogenetic Studies Form

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Cytogenetic Studies for Genetic Disorders in a Fetus

Indications

(539136) Is the cytogenetic study being performed to diagnose or treat a genetic disorder in a fetus? 

Contraindications

(539137) Is the cytogenetic study being performed for reasons other than diagnosis or treatment of a genetic disorder in a fetus? 

Cytogenetic Studies for Failure of Sexual Development

Indications

(539138) Is the cytogenetic study being performed to diagnose or treat failure of sexual development? 

Contraindications

(539139) Is the cytogenetic study being used for conditions not related to failure of sexual development? 

Cytogenetic Studies for Chronic Myelogenous Leukemia

Indications

(539140) Is the cytogenetic study being conducted as part of the diagnosis or treatment for chronic myelogenous leukemia (CML)? 

YesNoN/A
YesNoN/A
YesNoN/A

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Effective Date

07/16/1998

Last Reviewed

NA

Original Document

  Reference



Background for this Policy

The term cytogenetic studies is used to describe the microscopic examination of the physical appearance of human chromosomes.

Medicare covers these tests when they are reasonable and necessary for the diagnosis or treatment of the following conditions:

  • Genetic disorders (e.g., mongolism) in a fetus; (See the Medicare Benefit Policy Chapter 15, "Covered Medical and Other Health Services," §20.1)
  • Failure of sexual development;
  • Chronic myelogenous leukemia;
  • Acute leukemias lymphoid (FAB L1-L3), myeloid (FAB M0-M7), and unclassified; or
  • Mylodysplasia
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