Summary & Overview
CPT 82565: Creatinine, Quantitative (Blood)
CPT code 82565 identifies a quantitative measurement of creatinine in a patient specimen, typically performed on blood to evaluate kidney function and muscle metabolism. This common laboratory test underpins clinical decisions about renal function assessment, medication dosing, and monitoring of chronic kidney disease, making it a frequent and nationally relevant laboratory service.
Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for CPT code 82565, typical sites of service, and the operational role of the assay in care pathways. The publication also summarizes standard billing considerations, commonly applied modifiers (listed separately), and the types of benchmarks and policy updates that organizations track for laboratory CPT codes.
The piece is designed to inform billing managers, laboratory directors, and compliance staff about the clinical purpose of the code, where it is typically performed, and what to expect in payer coverage conversations. Data not available in the input will be noted where relevant in detailed sections.
Billing Code Overview
CPT code 82565 reports the measurement of creatinine in a patient specimen, most commonly performed on blood (serum or plasma) to assess kidney function and muscle metabolism. The test quantifies the amount of creatinine, a waste product produced by muscle breakdown of creatine, and is used in clinical evaluation of renal clearance, dosing decisions, and monitoring of chronic kidney disease.
Service Type: Clinical laboratory test — quantitative creatinine measurement
Typical Site of Service: Clinical laboratory or hospital laboratory; outpatient phlebotomy or ambulatory care settings for specimen collection
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an outpatient clinic or hospital laboratory for evaluation of renal function. The clinician orders serum creatinine measurement (82565) as part of a basic metabolic panel or directed renal workup for symptoms such as fatigue, edema, decreased urine output, or for routine monitoring of chronic kidney disease, hypertension, or medication effects (for example, dosing surveillance for renally excreted drugs). A phlebotomist collects a blood specimen (venous blood) following standard collection and labeling procedures and sends it to the clinical laboratory. The medical laboratory analyst performs the analytical procedure to quantify creatinine concentration, documents results in the laboratory information system, and reports values to the ordering provider. Typical sites of service include outpatient clinics, ambulatory infusion centers, emergency departments, and hospital inpatient or clinical laboratory settings.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the interpretation or professional component of a test that has separate technical and professional components (rare for basic chemistry but included if applicable). |
TC |