Summary & Overview
CPT 82010: Quantitative Ketone Bodies Assay, Serum or Plasma
CPT code 82010 represents a quantitative laboratory assay for ketone bodies in serum or plasma, delivering a numeric result used in diagnosis and monitoring of metabolic states such as diabetic ketoacidosis and other metabolic disorders. As a fully technical laboratory procedure, the code documents the analytic measurement that informs clinical decision-making and inpatient/outpatient care.
Key payers covered in this national overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise outline of the clinical context for quantitative ketone testing, typical sites of service, and the common modifier landscape that accompanies laboratory billing for this service. The publication also summarizes typical payer coverage patterns and coding considerations relevant to laboratories and clinical providers.
This piece provides operationally relevant benchmarks and policy context: how the code is used in practice, where it commonly appears on service lines, and what clinical situations typically generate orders for quantitative ketone measurement. Data not available in the input will be identified as such in relevant sections.
Billing Code Overview
CPT code 82010 describes a quantitative ketone bodies assay performed by a laboratory analyst on serum or plasma. The service produces a numeric measurement of ketone bodies rather than a qualitative positive/negative result.
Service type: Clinical laboratory/diagnostic test (technical component)
Typical site of service: Clinical laboratory, hospital laboratory, or outpatient phlebotomy/diagnostic facility
Clinical & Coding Specifications
Clinical Context
A patient with suspected diabetic ketoacidosis (DKA) or symptomatic ketosis presents to an emergency department, urgent care clinic, or hospital inpatient unit. The clinician orders a quantitative serum or plasma ketone analysis to determine the ketone body concentration for diagnosis, severity assessment, and monitoring of response to therapy. A phlebotomist collects a serum or plasma sample; the sample is transported to the clinical laboratory where a medical technologist or lab analyst performs 82010 to generate a numeric ketone value. Results are reviewed by the ordering clinician and integrated with bedside glucose, arterial blood gas, electrolytes, and clinical exam to guide fluid resuscitation, insulin therapy, and electrolyte replacement. Typical sites of service include hospital outpatient laboratory, emergency department, inpatient hospital laboratory, and ambulatory clinics with access to a certified reference laboratory.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the provider's interpretation/report of a laboratory test that has separable technical and professional components (rare for automated quantitative ketone assays). |
TC | Technical component | Use when billing only the laboratory's equipment, technician time, and supplies for the assay. |
90 | Reference (outside) laboratory | Use when the test is performed by an outside laboratory and billed by the ordering facility or provider. |
91 | Repeat clinical diagnostic laboratory test | Use when a subsequent quantitative ketone test is performed on the same day to monitor therapy or progression. |
52 | Reduced services | Use when the test is partially reduced or not performed to full extent documented. |
53 | Discontinued procedure | Use if specimen collection or testing was started but discontinued for documented clinical reasons. |
59 | Distinct procedural service | Use when billing multiple laboratory procedures on the same day that are not normally reported together and documentation supports distinct services. |
76 | Repeat procedure by same physician or other qualified health care professional | Use when the same quantitative ketone test is repeated by the same provider on the same date (note: 76 is not in the original modifier list; do not use if strict adherence required). |
90 | Duplicate entry suppressed | Note: 90 already listed; ensure not duplicated and use 90 only as defined above. |
QW | CLIA waived test | Use when the specimen is analyzed using a CLIA-waived quantitative ketone method in a waived setting. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207Q00000X | Clinical Laboratory Technologist | Performs and analyzes quantitative serum/plasma ketone assays in hospital or reference labs. |
| 207L00000X | Pathology | Pathologists oversee laboratory testing quality and interpretation in clinical labs. |
| 208000000X | Emergency Medicine | Emergency clinicians commonly order 82010 for acute metabolic presentations. |
| 261QM0800X | Internal Medicine | Hospitalists and internists manage DKA and order serial ketone measurements. |
| 207K00000X | Medical Technologist | Directly conducts the technical component of the assay in the lab. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
E10.10 | Type 1 diabetes mellitus with ketoacidosis without coma | Primary indication for quantitative serum ketone testing to confirm and monitor DKA in patients with type 1 diabetes. |
E11.10 | Type 2 diabetes mellitus with ketoacidosis without coma | Quantitative ketone measurement assists in diagnosis and severity assessment when DKA occurs in type 2 diabetes. |
E13.10 | Other specified diabetes mellitus with ketoacidosis without coma | Used for secondary or other specified diabetes types presenting with ketoacidosis; ketone quantitation is clinically relevant. |
R79.4 | Abnormal level of ketone bodies | Directly documents abnormal ketone findings and supports the medical necessity of quantitative testing. |
E11.65 | Type 2 diabetes mellitus with hyperglycemia | When hyperglycemia is present, ketone testing helps determine if ketosis or ketoacidosis is developing. |
R41.0 | Disorientation, unspecified | In patients with altered mental status, quantitative ketone testing may be part of the metabolic evaluation. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
80053 | Comprehensive metabolic panel | Provides glucose, electrolytes, and renal function data typically ordered alongside quantitative ketone testing to assess DKA and metabolic status. |
82947 | Glucose; quantitative, blood (except reagent strip) | Measures serum/plasma glucose necessary for diagnosis and management of ketosis and DKA; often ordered concurrently. |
83615 | Beta-hydroxybutyrate, quantitative | Alternative or companion quantitative ketone body test; directly related as another specific measurement of ketone bodies. |
82803 | Ketone bodies, semi-quantitative (urine) | Urine ketone testing may be performed as a preliminary or adjunct test; less specific than serum quantitation of 82010. |
80318 | Drug screen, definitive, quantitative (e.g., LC-MS/MS) | Not routinely paired but may be ordered in altered mental status workups where toxicology and metabolic causes are both considered. |