Flow Cytometry CPT code 88182 - 88189 - covered DX


Flow Cytometry is a highly complex process by which blood, body fluids, bone marrow and tissue can be examined. It provides important immunophenotypic and DNA cycle information, of both diagnostic and prognostic interest in hemopathology, cytopathology and general surgical pathology. The technique measures multiple characteristics (cell size, internal structure, antigens, DNA, ploidy and cell cycle analysis) of single cells in a moving fluid stream. Clinical analysis and interpretations are done by an experienced physician, usually a pathologist.

HIV Infection

The status of a Human Immunodeficiency Virus-
(HIV) infected patient can be monitored by the analysis of the surface antigen CD4 (a T-cell receptor for HIV). This information can contribute to a prognosis as well as medical management for that individual (e.g., the need for AZT therapy or prophylaxis). Monitoring would be considered appropriate no greater in frequency than every 3 months. (When a patient is stable, especially during the long period of clinical latency, assays would be appropriate at a frequency less often. When the patient has an acute problem or therapy change, it may be necessary to perform the test at an increased frequency.)

Leukemia or Lymphoma

Leukemias and lymphomas may be analyzed in tissue, blood or marrow. Sometimes, flow cytometry may be performed on peripheral blood and fine needle aspirate material, thus, avoiding more invasive procedures for diagnosis. The presence or absence of antigens is determined using an antibody panel for appropriate diagnosis and classification. In the great majority of cases, 20 antibody determinations are sufficient to address diagnostic and prognostic concerns. This process is usually necessary at the initial diagnostic phase, for separate hematologic malignancies or when tumor is present in several anatomic sites. After this initial diagnostic phase, flow cytometry may be indicated to determine response to therapy.

Organ Transplants

Postoperative monitoring of organ transplants may be necessary to determine early rejection, immunosuppressive therapy toxicity or differentiation of infection from allograft rejection. The cells surface marker examined is CD3. This may require repeated analysis when symptoms are expressed for the above conditions by the transplant patient.

Carcinomas

DNA analysis of tumor for ploidy and percent-S-
phase cells may be necessary for a few selective patients with carcinomas. Information obtained from flow cytometry is useful when the obtained prognostic information will affect treatment decisions in patients with low stage (localized disease). This is usually performed only one time after a diagnosis has been made and before treatment is initiated.

Primary Immunodeficiencies

Primary immunodeficiencies (e.g., Lymphocyte disorders, Phagocyte disorders, Monocyte/macrophage disorder) are immune disorders that are present at birth. These conditions are quite rare. Diagnosis typically occurs at an early age due to recurrent infections with frequent failures. Initial evaluation for suspected primary immunodeficiencies includes physical exam, laboratory evaluation (e.g., CBC, platelet, WBC with differential, ESR) and may include skin testing. Flow cytometry is indicated for diagnostic purposes in the presence of established disease or when abnormal results are found in the initial evaluation.

It is expected that the initial evaluation will contain a higher number of antibody examinations than a subsequent antibody examination.

Compliance with the provisions in this policy is subject to monitoring by post payment data analysis and subsequent medical review.
Notice: This LCD imposes diagnosis limitations that support diagnosis to procedure code automated denials. However, services performed for any given diagnosis must meet all of the indications and limitations stated in this policy, the general requirements for medical necessity as stated in CMS payment policy manuals, any and all existing CMS national coverage determinations, and all Medicare payment rules.
As published in CMS IOM 100-08, Section 13.5.1, to be covered under Medicare, a service shall be reasonable and necessary. When appropriate, contractors shall describe the circumstances under which the proposed LCD for the service is considered reasonable and necessary under Section 1862(a)(1)(A). Contractors shall consider a service to be reasonable and necessary if the contractor determines that the service is:
  • Safe and effective.
  • Not experimental or investigational (exception: routine costs of qualifying clinical trial services with dates of service on or after September 19, 2000, which meet the requirements of the clinical trials NCD are considered reasonable and necessary).
  • Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is:
    • Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member.
    • Furnished in a setting appropriate to the patient’s medical needs and condition.
    • Ordered and furnished by qualified personnel.
    • One that meets, but does not exceed, the patient’s medical need.
    • At least as beneficial as an existing and available medically appropriate alternative.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
12X, 13X, 14X, 18X, 21X, 71X, 72X, 83X, 85X
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
Note: TrailBlazer has identified the Bill Type and Revenue Codes applicable for use with the CPT/HCPCS codes included in this LCD. Providers are reminded that not all CPT/HCPCS codes listed can be billed with all Bill Type and/or Revenue Codes listed. CPT/HCPCS codes are required to be billed with specific Bill Type and Revenue Codes. Providers are encouraged to refer to the CMS Internet-Only Manual (IOM) Pub. 100-04, Claims Processing Manual, for further guidance.
030X, 031X
CPT/HCPCS Codes
Note:
Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book. The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) require the use of short CPT descriptors in policies published on the Web.
88182©
Cell marker study
88184©
Flowcytometry/ tc, 1 marker
88185©
Flowcytometry/tc, add-on
88187©
Flowcytometry/read, 2–8
88188©
Flowcytometry/read, 9–15
88189©
Flowcytometry/read, 16 & >
ICD-9-CM Codes That Support Medical Necessity
The CPT/HCPCS codes included in this LCD will be subjected to “procedure to diagnosis” editing. The following lists include only those diagnoses for which the identified CPT/HCPCS procedures are covered. If a covered diagnosis is not on the claim, the edit will automatically deny the service as not medically necessary.
Medicare is establishing the following limited coverage for CPT/HCPCS codes 88184, 88185, 88187, 88188, and 88189:
Covered for:
042
Human immunodeficiency virus (HIV) disease
079.51–079.53
Retrovirus
197.2
Secondary malignant neoplasm of respiratory and digestive systems, pleura
197.6
Secondary malignant neoplasm of respiratory and digestive systems, retroperitoneum and peritoneum
200.00–200.08
Reticulosarcoma
200.10–200.18
Lymphosarcoma
200.20–200.28
Burkitt’s tumor or lymphoma
200.30–200.38
Marginal zone lymphoma
200.40–200.48
Mantle cell lymphoma
200.50–200.58
Primary central nervous system lymphoma
200.60–200.68
Anaplastic large cell lymphoma
200.70–200.78
Large cell lymphoma
200.80–200.88
Other named variants
201.00–201.08
Hodgkin’s paragranuloma
201.10–201.18
Hodgkin’s granuloma
201.20–201.28
Hodgkin’s sarcoma
201.40–201.48
Lymphocytic-histiocytic predominance
201.50–201.58
Nodular sclerosis
201.60–201.68
Mixed cellularity
201.70–201.78
Lymphocytic depletion
201.90–201.98
Hodgkin’s disease
202.00–202.08
Nodular lymphoma
202.10–202.18
Mycosis fungoides
202.20–202.28
Szary’s disease
202.30–202.38
Malignant histiocytosis
202.40–202.48
Leukemic reticuloendotheliosis
202.50–202.58
Letterer-Siwe disease
202.60–202.68
Malignant mast cell tumors
202.70–202.78
Peripheral T cell lymphoma
202.80–202.88
Other lymphomas
202.90–202.98
Other and unspecified malignant neoplasms of lymphoid and histiocytic tissue
203.00
Multiple myeloma, without mention of having achieved remission
203.02
Multiple myeloma, in relapse
203.10–203.12
Plasma cell leukemia
203.80–203.82
Other immunoproliferative neoplasms
204.00–204.02
Acute lymphoid leukemia
204.10–204.12
Chronic lymphoid leukemia
204.20–204.22
Subacute lymphoid leukemia
204.80–204.82
Other lymphoid leukemia
204.90–204.92
Unspecified lymphoid leukemia
205.00–205.02
Acute myeloid leukemia
205.10–205.12
Chronic myeloid leukemia
205.20–205.22
Subacute myeloid leukemia
205.30–205.32
Myeloid sarcoma
205.80–205.82
Other myeloid leukemia
205.90–205.92
Unspecified myeloid leukemia
206.00–206.02
Acute monocytic leukemia
206.10–206.12
Chronic monocytic leukemia
206.20–206.22
Subacute monocytic leukemia
206.80–206.82
Other monocytic leukemia
206.90–206.92
Unspecified monocytic leukemia
207.00–207.02
Acute erythremia and erythroleukemia
207.10–207.12
Chronic erythremia
207.20–207.22
Megakaryocytic leukemia
207.80–207.82
Other specified leukemia
208.00–208.02
Acute leukemia of unspecified cell type
208.10–208.12
Chronic leukemia of unspecified cell type
208.20–208.22
Subacute leukemia of unspecified cell type
208.80–208.82
Other leukemia of unspecified cell type
208.90–208.92
Unspecified leukemia
238.71–238.77
Neoplasm of uncertain behavior, other lymphatic and hematopoietic tissues
238.79
Neoplasm of uncertain behavior, other lymphatic and hematopoietic tissues
273.1–273.3
Disorders of plasma protein metabolism
273.8–273.9
Disorders of plasma protein metabolism
279.00–279.06
Deficiency of humoral immunity
279.09
Deficiency of humoral immunity other
279.10–279.13
Deficiency of cell-mediated immunity
279.19
Deficiency of cell-mediated immunity other
279.2–279.3
Disorders involving the immune mechanism
279.41
Autoimmune lymphoproliferative syndrome
279.49
Autoimmune disease, not elsewhere classified
279.8–279.9
Disorders involving the immune mechanism
282.7
Other hemoglobinopathies
283.2
Hemoglobinuria due to hemolysis from external causes
284.01
Constitutional red blood cell aplasia
284.09
Other constitutional aplastic anemia
284.1–284.2
Aplastic anemia and other bone marrow failure syndromes
284.81
Red cell aplasia (acquired)(adult)(with thymoma)
284.89
Other specified aplastic anemias
284.9
Aplastic anemia, unspecified
285.0
Sideroblastic anemia
285.22
Anemia in neoplastic disease
285.8–285.9
Other and unspecified anemias
287.30–287.33
Primary thrombocytopenia
287.39
Other primary thrombocytopenia
287.5
Thrombocytopenia, unspecified
288.00–288.04
Neutropenia
288.09
Other neutropenia
288.1–288.4
Diseases of white blood cells
288.50–288.51
Decreased white blood cell count
288.59
Other decreased white blood cell count
288.60–288.65
Elevated white blood cell count
288.69
Other elevated white blood cell count
288.8–288.9
Diseases of white blood cells
289.4
Hypersplenism
289.50–289.53
Other diseases of spleen
289.59
Other diseases of spleen
289.83
Myelofibrosis
289.9
Unspecified diseases of blood and blood-forming organs
452
Portal vein thrombosis
453.9
Embolism of vein thrombosis, unspecified
785.6
Enlargement of lymph nodes
789.2
Splenomegaly
791.0
Proteinuria
795.4
Other nonspecific abnormal histological findings
996.80–996.87
Complications of transplanted organ
996.89
Complications of transplanted organ, other specified transplanted organ
V08
Asymptomatic human immunodeficiency virus (HIV) infection status
V10.60–V10.63
Personal history of malignant neoplasm , leukemia
V10.69
Personal history of malignant neoplasm, leukemia, other
V10.91
Personal history of malignant neuroendocrine tumor
V42.0–V42.7
Organ or tissue replaced by transplant
V42.81–V42.84
Organ or tissue replaced by transplant, other specified organ or tissue
V42.89
Organ or tissue replaced by transplant, other
V42.9
Unspecified organ or tissue replaced by transplant
Medicare is establishing the following limited coverage for CPT/HCPCS code 88182:
Covered for:
150.0–150.5
Malignant neoplasm of esophagus
150.8–150.9
Malignant neoplasm of esophagus
151.0–151.6
Malignant neoplasm of stomach
151.8–151.9
Malignant neoplasm of stomach
153.0–153.9
Malignant neoplasm of colon
154.0
Malignant neoplasm of rectosigmoid junction
154.1
Malignant neoplasm of rectum
174.0–174.6
Malignant neoplasm of female breast
174.8–174.9
Malignant neoplasm of female breast
175.0
Malignant neoplasm of nipple and areola of male breast
175.9
Malignant neoplasm of other and unspecified sites of male breast
183.0
Malignant neoplasm of ovary
183.8
Malignant neoplasm of other specified sites of uterine adnexa
185
Malignant neoplasm of prostate
188.0
Malignant neoplasm of trigone of urinary bladder
188.1–188.9
Malignant neoplasm of bladder
193
Malignant neoplasm of thyroid gland
194.0
Malignant neoplasm of adrenal gland
198.81
Secondary malignant neoplasm of breast
227.0
Benign neoplasm of adrenal gland
233.0
Carcinoma in situ of breast
259.2
Carcinoid syndrome
Note: Providers should continue to submit ICD-9-CM diagnosis codes without decimals on their claim forms and electronic claims.

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