Summary & Overview
CPT 85460: Fetomaternal Hemorrhage Test, Differential Lysis
CPT code 85460 denotes a laboratory diagnostic test that quantifies fetal red blood cells in maternal whole blood using a differential lysis technique to assess fetomaternal hemorrhage. This test is clinically significant in obstetric care when there is concern for fetal-maternal blood mixing after events such as trauma, invasive procedures, or unexplained fetal compromise. Nationally, accurate identification of fetomaternal hemorrhage informs subsequent management decisions, including Rh immune globulin dosing and neonatal risk assessment.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical indication and service setting for CPT code 85460, benchmark considerations for laboratory service lines, and the types of documentation and reporting elements that typically accompany this laboratory procedure. The publication also highlights common billing modifiers and payment nuances relevant to third-party reimbursement and hospital laboratory processing. Where specific payer policies or reimbursement amounts are not provided in the input, the summary notes that those data points are not available.
Billing Code Overview
CPT code 85460 describes a laboratory analysis performed on whole blood to evaluate fetomaternal hemorrhage. The test uses a differential lysis technique to determine the amount of fetal cells present in maternal circulation when fetal-to-maternal blood mixing is suspected.
Service Type: Laboratory diagnostic test
Typical Site of Service: Clinical laboratory or hospital laboratory
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A pregnant patient at 28 weeks gestation presents after a suspected abdominal trauma (motor vehicle collision) with concern for fetomaternal hemorrhage. Maternal vital signs are stable; fetal heart tones are monitored and stable. The obstetrics team orders laboratory evaluation to quantify fetal red blood cells in the maternal circulation to determine the need for additional Rh immune globulin or further fetal monitoring. A maternal whole blood sample is collected in the labor and delivery or outpatient phlebotomy setting and sent to the hospital or reference laboratory. The laboratory analyst performs a differential lysis technique to identify and quantify fetal cells mixed with maternal blood, documenting the percentage or volume of fetal-maternal hemorrhage and reporting results to the ordering clinician. Typical site of service: hospital laboratory, reference diagnostic laboratory, or hospital outpatient phlebotomy within an obstetrics unit. Typical service type: laboratory diagnostic test (special chemistry/hematology) using flow or microscopy-based differential lysis for fetomaternal hemorrhage assessment.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the professional component (interpretation) if facility separately bills the technical component. |
59 |