Summary & Overview
CPT 84275: Sialic Acid Measurement, Blood
CPT code 84275 represents a laboratory assay to measure sialic acid, most commonly performed on blood specimens. This biochemical test can inform diagnosis and monitoring of metabolic and genetic disorders, infectious processes, and certain malignancies where sialic acid levels are clinically relevant. Nationally, laboratory codes like 84275 matter because they drive clinical reporting, claims processing, and reimbursement for specialized biochemical testing across inpatient and outpatient settings.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise outline of the clinical purpose of the test, typical sites of service, and the payer landscape relevant to billing and coverage. The publication also summarizes common modifiers used with laboratory services, notes the absence of specified associated taxonomies and ICD-10 diagnoses in the input, and identifies where data was not provided.
The reader will learn the clinical context of the assay, the typical service delivery settings, and the scope of payers relevant to national billing considerations. Benchmarks, specific reimbursement rates, and detailed coverage policies are noted where available; when not provided, the text states that data is not available in the input. This overview is intended for healthcare administrators, coding professionals, and policy analysts seeking a concise reference to CPT code 84275 and its role in clinical laboratory services.
Billing Code Overview
CPT code 84275 describes a laboratory test performed by a lab analyst to measure sialic acid levels, typically from a patient blood specimen. The service is a clinical laboratory procedure used to quantify sialic acid concentration for diagnostic or monitoring purposes.
Service Type: Clinical laboratory testing
Typical Site of Service: Hospital laboratory, independent clinical laboratory, or outpatient laboratory collection site
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient for 84275 is an adult or pediatric patient evaluated for metabolic, genetic, or lysosomal storage disorders where measurement of sialic acid in serum or plasma assists diagnosis or monitoring. A common scenario is a neurologic referral for progressive developmental delay, hypotonia, seizures, or abnormal liver function tests. The clinician (pediatrician, medical geneticist, neurologist, or metabolic specialist) orders a blood draw for quantitative sialic acid measurement to assess for disorders such as sialidosis or congenital disorders of glycosylation.
The clinical workflow: the clinician documents the indication and orders 84275 in the electronic medical record. Phlebotomy is performed at an outpatient lab, inpatient ward, or specialty clinic; samples are processed per lab protocol (serum/plasma separation, proper storage) and sent to the clinical chemistry or reference laboratory. The laboratory analyst performs the sialic acid assay, interprets results relative to reference ranges, and reports findings to the ordering provider. Results inform diagnostic confirmation, genetic testing decisions, or treatment monitoring.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier applicable | Rarely used; default when no other modifier applies |