Summary & Overview
CPT 82960: G6PD Enzyme Assay in Red Blood Cells
CPT code 82960 identifies a quantitative enzymatic assay for glucose-6-phosphate dehydrogenase (G6PD) activity in red blood cells. This laboratory test is clinically important for detecting G6PD deficiency, a genetic condition that increases risk of hemolytic anemia when patients encounter certain oxidative medications, foods, or infections. Nationally, the code is used across hospital and reference laboratories and informs medication safety and diagnostic workups for hemolysis.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis addresses payer coverage patterns, common billing modifiers, and clinical context that affects utilization of the test.
Readers will find a concise clinical description, typical sites of service, and the practical billing context for lab administrators and clinicians. The publication highlights benchmarks and policy-relevant considerations affecting claims submission and reimbursement patterns for a widely used diagnostic assay. Data not available in the input is noted where specific payer policies or utilization metrics would normally appear.
Billing Code Overview
CPT code 82960 is a laboratory test that measures the activity of the glucose-6-phosphate dehydrogenase (G6PD) enzyme in red blood cells. The assay identifies a deficiency of the G6PD enzyme, which can leave red blood cells vulnerable to oxidative stress and at risk for hemolysis.
Service Type: Clinical Laboratory Test — Enzymatic Assay
Typical Site of Service: Clinical laboratory or hospital laboratory
Clinical & Coding Specifications
Clinical Context
A 6-year-old boy of Mediterranean descent presents to the pediatric clinic with jaundice and dark urine following exposure to a sulfonamide antibiotic prescribed for an upper respiratory infection. The clinician suspects acute hemolytic anemia possibly due to glucose-6-phosphate dehydrogenase (G6PD) deficiency. A venous blood sample is collected and sent to the laboratory for enzyme assay to measure G6PD activity. In the laboratory workflow, a technologist receives the sample, performs red blood cell separation if required, runs the G6PD quantitative enzyme assay (82960), and reports results indicating normal, deficient, or intermediate activity. Results are reviewed by the ordering clinician to confirm the diagnosis and guide counseling on oxidant exposures and medication avoidance. Typical sites of service include outpatient clinics, hospital inpatient wards (when hemolysis is acute), and reference laboratories that perform specialty hematology testing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when separately billing the professional interpretation component provided by a pathologist or laboratory physician distinct from technical testing. |
TC |