Summary & Overview
CPT 84235: Non-Estrogen/Progesterone Hormone Receptor Assay
CPT code 84235 denotes a laboratory assay that measures a hormone receptor level other than estrogen or progesterone in a patient specimen, commonly serum. The code is used for reporting specialized endocrine receptor testing that can influence diagnostic classification, treatment selection, and monitoring. Nationally, accurate coding of such tests matters for clinical decision-making, quality measurement, and appropriate claims processing for laboratory services.
Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for when this assay is used, typical sites of service where the test is performed, and the billing landscape relevant to major national payers. The publication outlines benchmark billing practices, common claim modifiers, and operational considerations for laboratories and billing departments.
The content provides a concise summary of the code’s clinical role, payer coverage landscape, and what to expect when submitting claims for this laboratory service. Data gaps in the input are identified as "Data not available in the input." The document is intended for a national audience of billing professionals, laboratory managers, and healthcare policy analysts seeking a clear reference on CPT code 84235.
Billing Code Overview
CPT code 84235 reports a laboratory assay that measures the level of a hormone receptor other than estrogen or progesterone receptors in a patient specimen, such as serum. This test is used to evaluate the presence or quantity of non-estrogen/non-progesterone hormone receptors that may inform diagnostic or monitoring decisions in endocrine and related clinical care.
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Service type: Clinical laboratory hormone receptor assay
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Typical site of service: Clinical laboratory or hospital laboratory (specimen collected in outpatient clinics, hospitals, or other healthcare settings and sent to a laboratory for analysis)
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Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with metastatic breast cancer undergoes serologic evaluation to determine the level of a hormone receptor other than estrogen or progesterone (for example, androgen receptor or HER-family receptor testing performed via serum assay). The clinician orders a laboratory quantitative receptor assay to assist in systemic therapy selection when tumor tissue is limited, prior therapy responses are equivocal, or serum monitoring of a circulating receptor is indicated. A phlebotomy is performed in an outpatient laboratory or hospital draw station; the specimen is sent to the clinical laboratory where a medical technologist or lab analyst performs the assay and reports a numeric receptor level and interpretive comment in the electronic medical record. Results are reviewed by the ordering oncologist or pathologist to guide targeted therapy decisions or to correlate with tissue-based immunohistochemistry and molecular testing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional component of the laboratory interpretation or consultative report separate from the technical processing. |
TC | Technical component |