Summary & Overview
CPT 84238: Laboratory Assay for Nonendocrine Receptor (Technical)
CPT code 84238 denotes the technical laboratory assay performed to detect the presence of nonendocrine receptors in clinical specimens such as serum, plasma, or tissue. This code captures the analytic, hands-on component of receptor testing and is used in claims that separate the technical component of laboratory diagnostics from professional reporting.
Nationally, accurate coding for 84238 matters because receptor testing informs diagnosis, treatment selection, and downstream utilization of targeted therapies. Proper use of the code affects laboratory reimbursement, claim adjudication, and contract performance across major payers. Key payers considered in this context include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of what 84238 represents, how it is typically performed and where, and what payers are relevant for coverage and payment considerations. The publication also outlines benchmarks and policy-related updates where available, and provides clinical context about the role of nonendocrine receptor testing in patient care. Data not available in the input will be explicitly noted in applicable sections.
Billing Code Overview
CPT code 84238 describes a technical laboratory assay performed by a lab analyst to test a clinical sample (for example, serum, plasma, or tissue) for the presence of a nonendocrine receptor. The procedure covers the hands-on, analytical component of detecting receptor proteins or related markers in biological specimens.
Service type: Laboratory diagnostic assay — technical component
Typical site of service: Clinical laboratory or hospital laboratory
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult referred by an oncologist or pathologist for tumor receptor testing to guide targeted therapy. A 62-year-old patient with a newly diagnosed metastatic carcinoma has a biopsy of a liver lesion submitted to the clinical laboratory. The lab receives the serum and tissue specimens and the pathologist requests ancillary receptor testing for a nonendocrine receptor to determine eligibility for receptor-targeted agents.
The clinical workflow: the specimen accessioning team verifies patient and order information; the histology/cytology team prepares tissue sections or isolates plasma/serum; the laboratory analyst performs the technical assay (immunohistochemistry, flow cytometry, or molecular receptor assay) to detect the presence of the specified nonendocrine receptor; the technical results are reviewed and validated by the laboratory director/pathologist; the professional component (interpretation and report) is issued to the ordering provider. Billing for the technical assay component is reported with 84238 for the analytic procedure performed on serum, plasma, or tissue to test for a nonendocrine receptor.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the interpretation/report by the physician (pathologist) separate from the lab's technical work. |