Summary & Overview
CPT 82955: G6PD Enzyme Assay, Whole Blood
CPT code 82955 represents a laboratory assay that measures glucose-6-phosphate dehydrogenase (G6PD) activity in whole blood to detect G6PD deficiency, a hereditary enzyme disorder linked to hemolytic anemia. Nationally, identification of G6PD deficiency matters for patient safety and medication management because affected individuals can experience acute hemolysis after exposure to specific drugs, foods, or infections. This test supports diagnostic confirmation and preventive clinical decision-making.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service setting, benchmarking information where available, common billing modifiers, and notes on payer coverage patterns. The publication summarizes typical sites of service, how the assay is used in diagnostic workflows, and what implications the test result has for ongoing care management. Data not provided in the input, such as specific reimbursement rates, contracted payer policies, and associated ICD-10 codes, are identified as unavailable. The content is focused on national policy and clinical implications rather than state-level rules.
Billing Code Overview
CPT code 82955 measures glucose-6-phosphate dehydrogenase (G6PD) activity in red blood cells from a whole blood specimen. The test identifies G6PD enzyme deficiency, a genetic condition that can cause red blood cell hemolysis when triggered by certain foods, medications, or infections. Clinically, this assay is used to confirm suspected hemolytic episodes and to guide avoidance of oxidative triggers.
Service type: Laboratory testing — enzyme assay
Typical site of service: Clinical laboratory or hospital laboratory
Clinical & Coding Specifications
Clinical Context
A 28-year-old pregnant patient of Southeast Asian descent presents to an outpatient laboratory after a primary care visit noted a history of neonatal jaundice in a prior child and recent symptoms of fatigue and dark urine following a course of trimethoprim-sulfamethoxazole for a urinary tract infection. The clinician orders a quantitative glucose-6-phosphate dehydrogenase (G6PD) assay to evaluate for enzyme deficiency as a cause of hemolytic anemia.
Specimen is collected as whole blood via venipuncture and sent to the clinical laboratory. The lab analyst performs the quantitative measurement of G6PD activity in red blood cells using standardized spectrophotometric or point-of-care methods. Results are reviewed by the laboratory director and reported to the ordering clinician. Typical site of service is an outpatient laboratory or hospital clinical laboratory; testing may also be performed in an inpatient setting when hemolysis is suspected on admission. The workflow includes: order entry by provider, patient identification and informed consent, phlebotomy, specimen transport, assay processing, result validation, and electronic reporting to the clinician.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation/consultative component if the laboratory separates technical and professional components. |