Summary & Overview
CPT 3496F: CD4+ Count 500 cells/mm3 or Higher
CPT code 3496F is a supplemental tracking code indicating that a patient’s CD4+ T-lymphocyte count is 500 cells/mm3 or higher. As a clinical status marker, this code is used alongside diagnostic and laboratory reporting to document immunologic stability in patients, commonly in HIV care. Nationally, accurate use of this code supports quality measurement, care coordination, and population health reporting related to immune function.
Key payers in standard analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise context on the clinical meaning of the code, typical service settings for its use, and what to expect in payer coverage patterns. The publication also outlines common data elements and benchmarking considerations for supplemental tracking codes used in HIV and immunology management.
This summary provides clinicians, coding staff, and policy analysts with a clear view of the code’s purpose, its role in clinical documentation and reporting, and the types of benchmarks and policy updates that affect supplemental immunologic tracking codes nationally.
Billing Code Overview
CPT code 3496F documents that the patient’s CD4+ cell count is 500 cells/mm3 or higher. This is a supplemental tracking code used to indicate immunologic status for patients, typically in the context of HIV care and monitoring.
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Service type: Laboratory result tracking / clinical surveillance
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Typical site of service: Outpatient clinic or ambulatory care setting, including infectious disease clinics and HIV specialty programs
Data not available in the input for payers, modifiers, taxonomies, ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult living with HIV who attends an outpatient infectious disease or primary care clinic for routine monitoring. The visit includes a focused laboratory order for CD4+ lymphocyte count as part of ongoing disease monitoring and antiretroviral therapy (ART) effectiveness assessment. The clinical workflow: the clinician documents the indication and orders a CD4+ absolute count; phlebotomy is performed in the clinic or an affiliated lab; results are returned to the clinician; the clinician documents the CD4+ cell count result in the medical record. When the documented CD4+ cell count is 500 cells/mm3 or higher, the supplemental tracking code 3496F is reported in the medical record or quality reporting systems to indicate the patient meets this threshold for immune status monitoring.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of a procedure | Use when a distinct E/M is performed and documented on the same day as services related to HIV care or lab ordering |
26 | Professional component |