CurrentBlue Cross Blue Shield - TennesseePolicy N/A

Flow Cytometry — Reimbursement Policy

This policy governs coverage and reimbursement rules for flow cytometry testing (immunophenotyping, cell enumeration, DNA/cell cycle analysis) for BlueCross BlueShield of Tennessee members and describes indications, limitations, and applicable CPT/HCPCS coding and billing rules.

Policy Summary

PayerBlue Cross Blue Shield - Tennessee

PolicyFlow Cytometry — Reimbursement Policy

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionUse code 88184 for the first marker (reimbursable up to 2 units per date of service) and 88185 for each additional marker (reimbursable up to 35 units per date of service).

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

10+Covered clinical indications

288184 unit limit

3588185 unit limit

1/unitInterpretation codes limit

Not coveredDNA/S-phase testing

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.

Flow Cytometry Coverage and Limitations

Flow cytometry coverage criteria and limitations

Covered when ALL of the following grouped conditions and coding rules are met:

Flow cytometry testing is subject to the following covered indications and limitations.

Covered indications (ONE or more of the following)

Cytopenias, lymphomas, leukemia, myeloproliferative and lymphoproliferative disorders, or myelodysplastic syndrome.
B-cell monitoring for immunosuppressive disorders.
T-cell monitoring for HIV infection and AIDS.
Mast cell neoplasms.
Paroxysmal nocturnal hemoglobinuria.
Preoperative or postoperative monitoring for individuals undergoing organ transplantation.
Plasma cell disorders.
Primary immunodeficiencies (PIDs).
Primary platelet disorders (non-neoplastic).
Red cell and white cell disorders (non-neoplastic).

Coding and unit limits (ALL apply)

For assessment of potential hematolymphoid neoplasia, use CPT codes 88184 through 88189.
Use code 88184 for the first marker, per specimen; reimbursable up to a maximum of 2 units per date of service.
Use code 88185 for each additional marker; reimbursable up to a maximum of 35 units per date of service.
In patients with a neoplasm with an established immunophenotype, subsequent testing should be limited to diagnostically relevant markers.
Codes 88187, 88188, and 88189 should not be used together for a single specimen in any combination; each of these codes is reimbursed at one unit per specimen, up to two specimens per date of service.
Do not bill codes 88187-88189 in conjunction with codes 86355, 86356, 86357, 86359, 86360, 86361, or 86367.

Noncovered uses (must NOT be billed as covered)

Measurement of flow cytometry–derived DNA content (DNA Index) or cell proliferative activity (S-phase fraction or % S-phase) for prognostic or therapeutic purposes in the routine clinical management of cancers does NOT meet coverage criteria.

Operational note: Application of these coverage criteria is dependent upon an individual’s benefit coverage at the time of the request; applicable state and federal regulations (e.g., LCDs, NCDs, Medicaid) take precedence where they conflict.

Applicable CPT/HCPCS Codes and Unit Limits

Referenced CPT/HCPCS codes and descriptionsCPT

86355	B cells, total count
86356	Mononuclear cell antigen, quantitative (eg, flow cytometry), not otherwise specified, each antigen
86357	Natural killer (NK) cells, total count
86359	T cells; total count
86360	T cells; absolute CD4 and CD8 count, including ratio
86361	T cells; absolute CD4 count
86367	Stem cells (ie, CD34), total count
88182	Flow cytometry, cell cycle or DNA analysis
88184	Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; first marker
88185	Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; each additional marker (List separately in addition to code for first marker)

1–10 of 13

1/2

Maximum units — CPT 88184

Maximum units for 881842 units per date of service

Usage noteCode 88184 = first marker, per specimen

Associated codesUsed with 88185 for additional markers; see interpretation code limits

Maximum units — CPT 88185

Maximum units for 8818535 units per date of service

Usage noteCode 88185 = each additional marker

Billing contextApply per date of service when reporting multiple additional markers

Interpretation codes — unit and specimen limits

Interpretation codes (88187–88189) unit/specimen limitReimbursed 1 unit per specimen, up to 2 specimens per date of service

Mutual exclusivity88187–88189 should not be used together for a single specimen in any combination

Do not pair withDo not bill 88187–88189 with codes 86355, 86356, 86357, 86359, 86360, 86361, 86367

Billing and Documentation Rules for Providers

Billing Rule

Billing and coding rules for flow cytometry

Use CPT 88184 for the first marker (per specimen) and CPT 88185 for each additional marker; 88184 is reimbursable up to a maximum of 2 units per date of service and 88185 is reimbursable up to a maximum of 35 units per date of service. Do not bill interpretation codes 88187–88189 together for a single specimen; those codes are reimbursed one unit per specimen, up to two specimens per date of service. Do not bill 88187–88189 in conjunction with cell enumeration codes 86355, 86356, 86357, 86359, 86360, 86361, or 86367; use 86355/86357/86359/86360/86361/86367 for cell enumeration as single units only. Limit subsequent testing in neoplasms with an established immunophenotype to diagnostically relevant markers.

First marker: CPT 88184 — reimbursable up to 2 units per date of service
Additional markers: CPT 88185 — reimbursable up to 35 units per date of service
Interpretation codes 88187–88189: reimbursed 1 unit per specimen, up to 2 specimens per date of service; do not use together for a single specimen
Do not bill 88187–88189 with 86355, 86356, 86357, 86359, 86360, 86361, or 86367
Use 86355, 86357, 86359, 86360, 86361, or 86367 for cell enumeration as single units only
In neoplasms with established immunophenotype, limit repeat testing to diagnostically relevant markers

Key Terms and Definitions

S‑phase fraction (SPF)

DefinitionS-phase fraction (SPF) is the assessment of the percentage of cells actively synthesizing DNA within a cell population

Intended useUsed as a measure of cell proliferation, particularly in cancer

Clinical implicationA high SPF value is indicative of rapid cancer growth

Laboratory‑developed test (LDT)

DefinitionLaboratory-developed test (LDT) = a test developed and validated in-house by a laboratory

Regulatory contextLDTs are regulated by CMS as high-complexity tests under CLIA '88

FDA statusLDTs are not approved or cleared by the U.S. Food and Drug Administration; FDA clearance/approval is not currently required for clinical use