CPT 84202: Protoporphyrin Measurement in Blood

CPT code 84202 denotes a laboratory diagnostic test that measures blood protoporphyrin, a component involved in hemoglobin formation. This test is used in clinical evaluation of disorders related to hemoglobin synthesis and iron incorporation. Nationally, accurate coding of such laboratory procedures supports appropriate clinical interpretation, billing consistency, and public health surveillance where porphyrin-related values inform diagnostic pathways.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical purpose of the assay, typical service and site-of-service settings, and the payer landscape relevant to coverage considerations. The publication outlines common modifiers associated with laboratory claims, notes where input data were unavailable, and identifies areas where readers can expect benchmarks or policy summaries when data are present.

This summary aims to provide clinical context for coding and billing professionals, laboratory administrators, and policy analysts who need a clear, national-level description of what CPT code 84202 represents and where it is typically performed. Data not available in the input are noted where applicable in the full publication.

Billing Code Overview

CPT code 84202 describes a laboratory test that measures the amount of protoporphyrin in a patient's blood. The assay quantifies protoporphyrin, a substance that binds with iron-containing proteins to form hemoglobin, and is performed by a laboratory analyst who typically collects the specimen by venipuncture.

Service type: Laboratory diagnostic test

Typical site of service: Clinical laboratory or hospital laboratory with phlebotomy (blood draw) capability

Clinical Context

A 5-year-old child presents to a primary care clinic for evaluation of pallor and suspected iron deficiency anemia. The clinician obtains a venous blood specimen for laboratory analysis, including a quantitative protoporphyrin level to assess for iron-deficient erythropoiesis and to assist differentiation from lead exposure. The phlebotomy is performed by a trained technician via simple venipuncture in the clinic laboratory; the lab analyst performs the assay and reports the protoporphyrin concentration to the ordering provider. Typical workflow: clinician orders test, patient undergoes venipuncture at clinic or outpatient laboratory, specimen processed by clinical laboratory using appropriate hematology/biochemistry methods, result posted to the medical record and interpreted by the clinician in the context of hemoglobin, ferritin, and lead screening results.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing for the professional interpretation or reporting component separate from the facility/lab technical work.
`TC`	Technical component	Use when billing for the technical component (laboratory instrument and personnel) when the professional interpretation is billed separately.

Taxonomy Code	Specialty	Notes
335100000X	Clinical Laboratory	Laboratory professionals and clinical pathologists who perform and supervise laboratory testing.
207RC0000X	Internal Medicine	Primary care and pediatric clinicians who order protoporphyrin testing for anemia workup.
208000000X	Pediatrics	Pediatricians who evaluate children with anemia or lead exposure risk and order this test.
207K00000X	Family Medicine	Family physicians who order and interpret outpatient laboratory testing for iron deficiency.
207L00000X	Hematology	Hematologists who may request protoporphyrin testing as part of specialized anemia evaluation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`D50.9`	Iron deficiency anemia, unspecified	Common indication for protoporphyrin testing to assess iron-deficient erythropoiesis.
`D64.9`	Anemia, unspecified	Used when anemia is identified and further laboratory evaluation including protoporphyrin is ordered.
`Z13.5`	Encounter for screening for other metabolic and endocrine disorders	May apply when screening high-risk populations (e.g., children) for lead exposure or porphyrin abnormalities.
`T56.0X5A`	Toxic effect of lead and its compounds, accidental (initial encounter)	Protoporphyrin can be elevated in lead exposure and supports lead toxicity evaluation.
`E61.1`	Iron deficiency due to inadequate dietary iron intake	Clinical context where protoporphyrin measurement helps confirm iron-deficient erythropoiesis.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36415`	Collection of venous blood by venipuncture	Performed immediately before `84202` to obtain the specimen for protoporphyrin measurement.
`84156`	Urine porphobilinogen; quantitative	Performed when a broader porphyrin panel or porphyria evaluation is indicated in conjunction with protoporphyrin testing.
`85014`	Blood count; automated differential WBC count	Performed alongside `84202` to evaluate hemoglobin/hematocrit and red cell indices in anemia workup.
`83020`	Hemoglobin; glycosylated (A1C)	May be ordered in differential workups when metabolic contributors to anemia are also assessed.
`83655`	Iron; serum	Commonly ordered with protoporphyrin to evaluate iron status and support diagnosis of iron deficiency.

OpenPayer

Summary & Overview