Summary & Overview
CPT 3495F: CD4+ Cell Count 200–499 cells/µL
CPT code 3495F denotes a documented CD4+ T‑cell count in the range of 200–499 cells/µL and is used to convey immune status for patients with HIV. Nationally, CD4 reporting codes like 3495F are important for clinical tracking, quality measurement, and lab claim adjudication because they communicate risk stratification and may affect monitoring frequency and care coordination. This publication addresses the clinical context of CD4 counts, how 3495F is applied in practice, and implications for lab and outpatient billing workflows.
Key payers covered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise description of the code's clinical meaning, typical service setting, and the types of information payers commonly require to process claims for CD4 testing. The report also outlines commonly examined benchmarks and policy considerations relevant to CD4 documentation and laboratory coding. Evidence tables and billing guidance are not included here; where payer-specific policies or coverage rules are not provided, the text notes that data are not available in the input. The focus is national in scope and intended for billing managers, laboratory administrators, and clinicians involved in HIV care and reporting.
Billing Code Overview
CPT code 3495F documents a CD4+ cell count level recorded by a provider. The code indicates a measured cluster of differentiation 4 (CD4) T‑lymphocyte count of 200 to 499 cells per microliter of blood, used to assess immune function in people with human immunodeficiency virus (HIV).
Service Type: Laboratory test — CD4+ lymphocyte count
Typical Site of Service: Clinical laboratory or outpatient phlebotomy location
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 38-year-old patient with known HIV infection presents for routine monitoring. The primary infectious disease clinician orders a 3495F CD4+ cell count after the patient reports intermittent fevers and weight loss, and to assess immune status prior to modifying antiretroviral therapy. The clinical workflow begins with the outpatient visit to an infectious disease clinic or primary care clinic with HIV expertise. A phlebotomy draw is collected in the clinic or a laboratory draw station; the specimen is sent to the hospital or reference laboratory for flow cytometry to quantify CD4+ T-lymphocytes. Results are reported in cells per microliter; a documented result in the range of 200–499 cells/µL is coded with 3495F. The provider reviews the result, documents the numeric CD4+ count and interpretation, and uses the information for risk stratification, opportunistic infection prophylaxis decisions, and treatment planning. Typical sites of service include outpatient infectious disease clinics, hospital outpatient labs, federally qualified health centers, and standalone phlebotomy centers.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure | Use when an E/M visit is performed on the same day as blood draw and is distinct from the laboratory service |