CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPLAB001

Flow Cytometry

Defines BCBSNM coverage and reimbursement rules for flow cytometry immunophenotyping and related assays for eligible members and providers subject to plan documents and provider contracts.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyFlow Cytometry

Policy CodePolicy CPCPLAB001

Change TypeRevision with material change

Effective DateOct 30, 2024

Next Review DateN/A

Key ActionSubmit claims with accurate documentation and valid HIPAA-approved codes; claims may be subject to review and require additional documentation upon request.

SourceLink

POLICY UPDATE CHANGES

Statement 1f was revised to include pre-operative monitoring and now reads: For preoperative or post-operative monitoring of individuals who will undergo or who have undergone organ transplantation.

Bill Type Codes were removed from the document.

References were revised; some added and others updated.

10Listed clinical indications

12Procedure codes referenced

Max 288184 limit

Max 3588185 limit

1/unit/specimen

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Reimbursable Indications and Criteria

Reimbursable indications and coding limits

Flow cytometry immunophenotyping of cell surface markers may be reimbursable when medically indicated for the conditions listed below and subject to the coding and unit limits that follow.

ALL of the following

ANY of the following
- cytopenias
- lymphomas
- leukemia
- myeloproliferative and lymphoproliferative disorders
- myelodysplastic syndrome
- B-cell monitoring for immunosuppressive disorders
- T-cell monitoring for HIV infection and AIDS
- mast cell neoplasms
- paroxysmal nocturnal hemoglobinuria
- pre-operative or post-operative monitoring for individuals who will undergo or who have undergone organ transplantation
- plasma cell disorders
- primary immunodeficiencies (including T- and NK-cell involvement)
- primary platelet disorders (non-neoplastic)
- red cell and white cell disorders (non-neoplastic)

ALL of the following

Flow cytometry immunophenotyping is not reimbursable for any clinical condition not listed in the reimbursable indications.

ALL of the following

Use CPT codes 88184–88189 for assessment of potential hematolymphoid neoplasia.
Code 88184: use for the first marker, per specimen; reimbursable up to a maximum of 2 units per date of service.>= 0
Code 88185: use for each additional marker; reimbursable up to a maximum of 35 units per date of service.>= 0
Codes 88187, 88188, 88189: reimbursed at one unit per specimen, up to two specimens per date of service; these codes must not be used together for a single specimen.
Codes 88187–88189 should not be used in conjunction with codes 86355, 86356, 86357, 86359, 86360, 86361, or 86367.

ALL of the following

Use codes 86355, 86357, 86359, 86360, 86361, or 86367 for cell enumeration; these are reimbursable as single units only.

ALL of the following

Measurement of DNA index or cell proliferative activity (S-phase fraction or % S-phase) for prognostic or therapeutic purposes in routine clinical cancer management is not reimbursable.

ALL of the following

Providers must submit accurate documentation and valid HIPAA-approved codes; claims are subject to claim review and may require additional documentation upon request.
If a conflict exists between this policy and a plan document or provider contract, the plan document or provider contract governs.

CPT/HCPCS Codes and Unit Limits

Referenced CPT/HCPCS codesmixed

88184	Flow cytometry; first marker, per specimen
88185	Flow cytometry; each additional marker
88187	Flow cytometry panel (higher complexity) - reimbursed per specimen limits apply
88188	Flow cytometry panel (higher complexity) - reimbursed per specimen limits apply
88189	Flow cytometry panel (higher complexity) - reimbursed per specimen limits apply
86355	Cell enumeration/flow cytometry
86356	Cell enumeration/flow cytometry
86357	Cell enumeration/flow cytometry
86359	Cell enumeration/flow cytometry
86360	Cell enumeration/flow cytometry

1–10 of 13

1/2

88184 unit limit

Code88184

LimitReimbursable up to a maximum of 2 units per date of service

DescriptorFlow cytometry; first marker, per specimen (use for first marker)

88185 unit limit

Code88185

LimitReimbursable up to a maximum of 35 units per date of service

DescriptorFlow cytometry; each additional marker (use for additional markers)

Documentation, Claims, and Billing Instructions

Documentation Required

Documentation, coding, and claim review requirements

Providers must submit accurate documentation of services and bill using valid HIPAA‑approved code combinations. Claims are subject to code edit protocols and claim review and may require submission of additional documentation upon request.

Submit claims using valid code combinations from HIPAA‑approved code sets and code appropriately per industry standard coding guidelines (e.g., UB, CPT, HCPCS, ICD‑10).
Be prepared to provide additional documentation if requested during claim review.

Plan Documents and Governing Materials

Plan documents

Plan documents (governing order)Certificates of Health Care Benefits, benefit booklets, Summary Plan Descriptions, and other coverage documents

Conflict ruleIf a conflict arises between this policy and a plan document, the plan document governs; if conflict with a provider contract, the provider contract governs

BCBSNM discretionBlue Cross and Blue Shield of New Mexico may use reasonable discretion in interpreting and applying this policy to specific cases