Summary & Overview
CPT 86353: Lymphocyte Blastogenesis Assay for T-Cell Function
CPT code 86353 represents a lymphocyte blastogenesis assay — a specialized laboratory test that measures T‑cell proliferation in response to mitogens or antigens to evaluate cellular immune function. This test is used in the diagnostic workup of patients with suspected immunodeficiency and in select clinical scenarios where cellular immunity status informs care. Nationally, access to and reimbursement for specialized immunology assays can affect diagnostic pathways for complex immune disorders and transplant evaluation.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise overview of clinical context, coverage considerations across major payers, typical sites of service, and common billing practices tied to the assay.
Readers will learn what CPT code 86353 denotes clinically, where the test is typically performed, and which major payers are relevant to coverage discussions. The report summarizes benchmarks and payer coverage presence where available, highlights common billing modifiers and administrative considerations, and situates the assay within broader immunology laboratory services. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 86353 describes a laboratory test in which a lab analyst performs a mitogen or antigen induced blastogenesis to evaluate T‑cell function in patients with suspected or confirmed immunodeficiency. The procedure assesses lymphocyte proliferation in response to mitogens or specific antigens to characterize cellular immune competence.
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Service type: Clinical laboratory immunology test (lymphocyte proliferation/blastogenesis assay)
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Typical site of service: Hospital laboratory or independent clinical laboratory equipped for cellular immunology testing. Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A patient is referred to an immunology or clinical laboratory service for evaluation of suspected T‑cell immunodeficiency following recurrent or severe infections, failure to thrive in a pediatric patient, or abnormal screening tests (such as low lymphocyte counts or abnormal flow cytometry). The ordering clinician (commonly a pediatrician, allergist/immunologist, infectious disease specialist, or hematologist) documents history, physical exam findings, relevant laboratory results, and the clinical question: assessment of T‑cell proliferative capacity.
The patient arrives to an outpatient infusion or phlebotomy area or an outpatient laboratory collection suite. Peripheral blood is drawn and transported to the immunology laboratory. The lab analyst performs a mitogen or antigen‑induced lymphocyte blastogenesis assay (CPT 86353) by incubating patient T cells with mitogens (e.g., phytohemagglutinin) or specific antigens, measuring proliferation (commonly by tritiated thymidine uptake or alternative proliferation readouts). Results are interpreted by the laboratory with correlation to clinical history; abnormal or absent proliferation supports T‑cell functional defects and prompts referral for further immunologic workup (e.g., flow cytometry, genetic testing). Typical sites of service include hospital outpatient laboratories, independent clinical laboratories, and specialized immunology reference laboratories. The specimen handling, incubation, and reporting workflow requires qualified laboratory personnel and may include both technical (laboratory) and professional (interpretive) components of service depending on facility billing practices.
Coding Specifications
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