Summary & Overview
CPT 84220: Pyruvate Kinase Activity Assay, Blood
CPT code 84220 represents a laboratory procedure to measure pyruvate kinase activity in a patient specimen, most commonly blood. This enzymatic assay is used in the clinical evaluation of metabolic and hematologic disorders where pyruvate kinase levels inform diagnosis, disease monitoring, or further genetic and biochemical workup. Nationally, accurate reporting of specialized laboratory codes like 84220 supports appropriate clinical decision-making and claims processing for biochemical diagnostic services.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for the test, typical sites of service, and common billing considerations tied to laboratory reporting. The publication also summarizes benchmarking information where available, highlights policy or coverage updates affecting enzymatic laboratory testing, and outlines operational factors relevant to laboratories and billing teams.
This material is intended to give clinicians, laboratory managers, and billing specialists a national-level view of CPT code 84220, including clinical purpose, billing context, and what to expect in payer coverage and administrative handling. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 84220 reports a laboratory assay to measure pyruvate kinase activity in a patient specimen, typically performed on a blood sample. This test assesses the level of the enzyme pyruvate kinase, which is important for evaluating certain metabolic and hematologic conditions.
Service Type: Clinical laboratory diagnostic test
Typical Site of Service: Clinical laboratory or hospital laboratory (blood specimen)
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to hematology or primary care with chronic hemolytic anemia, unexplained jaundice, splenomegaly, or a history of neonatal jaundice and recurrent transfusion dependence. The clinician orders a quantitative pyruvate kinase (PK) activity assay on a fresh whole blood sample to evaluate for pyruvate kinase deficiency, a congenital hemolytic disorder. The clinical workflow: the phlebotomist collects an EDTA whole blood specimen and promptly delivers it to the clinical laboratory on chilled transport per laboratory protocol; the laboratory technologist documents specimen integrity and runs a spectrophotometric or enzymatic assay to determine PK activity; results are reviewed by a laboratory director and reported to the ordering clinician; results are correlated with red cell indices, peripheral smear, hemolysis markers (LDH, haptoglobin, bilirubin), and genetic testing when indicated. The typical site of service is an outpatient clinic or hospital laboratory; testing can be ordered by hematologists, pediatricians, internists, or transfusion medicine specialists.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the professional interpretation or consultation portion is billed separately by the pathologist or laboratory director. |
TC |