CurrentBlue KCPolicy POL-PP-280-AHS-F2019

Payment Integrity Compliance — Flow Cytometry

Defines Blue KC's reimbursement and billing rules for flow cytometry testing, including applicable codes, limitations, and eligible clinical indications; affects professional and facility providers submitting claims to Blue KC across listed lines of business.

Policy Summary

PayerBlue KC

PolicyPayment Integrity Compliance — Flow Cytometry

Policy CodePolicy POL-PP-280-AHS-F2019

Change TypeNo material changes

Effective DateJul 1, 2025

Next Review DateJul 1, 202621d

Key ActionBlue KC may request medical records to determine coverage; include all necessary information for a coverage determination.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

88184-88189Primary interpretation/technical flow cytometry code range referenced

Max 2Max reimbursable units for 88184/date

Max 35Max reimbursable units for 88185/date

Not combinable88187-88189 combinability

2Related Blue KC hematopathology/genomic policies

Flow Cytometry Coverage Criteria

Reimbursement for flow cytometry immunophenotyping and related testing may be allowed when medically indicated for the following conditions and is subject to the billing limits below.

ALL of the following

ANY of the following
- Cytopenias
- Lymphomas
- Leukemia
- Myeloproliferative and lymphoproliferative disorders

Policy Summary

PayerBlue KC

PolicyPayment Integrity Compliance — Flow Cytometry

Policy CodePolicy POL-PP-280-AHS-F2019

Change TypeNo material changes

Effective DateJul 1, 2025

Next Review DateJul 1, 202621d

Key ActionBlue KC may request medical records to determine coverage; include all necessary information for a coverage determination.

SourceLink

On This Page

ALL of the following

Use CPT codes 88184–88189 for assessment of potential hematolymphoid neoplasia
CPT 88184: report for the first marker per specimen; reimbursable up to a maximum of 2 units per date of service
CPT 88185: report for each additional marker; reimbursable up to a maximum of 35 units per date of service
CPT 88187, 88188, 88189: each reimbursed at one unit per specimen, up to two specimens per date of service
CPT 88187–88189 should not be used together for a single specimen in any combination
Do not report CPT 88187–88189 in conjunction with CPT 86355, 86356, 86357, 86359, 86360, 86361, or 86367
Use CPT 86355, 86357, 86359, 86360, 86361, or 86367 for cell enumeration; these are reimbursable as single units only

Procedure Codes, Unit Limits, and Specimen Rules

Listed flow cytometry and cell enumeration codesCPT

86355	B cells, total count
86356	Mononuclear cell antigen, quantitative, 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 (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

1–10 of 13

1/2

88184 units limit

Code88184

UsageFirst marker, per specimen

Unit limitReimbursable up to a maximum of two units per date of service (first marker per specimen)

88185 units limit

Code88185

UsageEach additional marker (technical component)

Unit limitReimbursable up to a maximum of 35 units per date of service

88187-88189 specimen limits

Codes88187, 88188, 88189

Specimen billingReimbursed at one unit per specimen, up to two specimens per date of service

Combination ruleCodes 88187-88189 should not be used together for a single specimen

Documentation and Medical Records Requests

Documentation Required

Medical records may be requested for coverage determination

Blue KC may request medical records to determine coverage. When medical records are requested, letter support and/or explanation can be useful but are not sufficient unless all specific information needed to make a coverage determination is included.

Provide complete medical records that contain the specific clinical information requested for coverage determination.
If submitting a supporting letter or explanation, ensure it includes all specific information noted in the records request; letters alone are insufficient.

Key Terms

S-phase fraction (SPF)

TermS-phase fraction (SPF)

DefinitionProportion of cells actively synthesizing DNA used as a measure of cell proliferation

Clinical meaningHigh SPF indicates rapid cancer growth and is used prognostically/therapeutically in cancer management

Flow cytometry

TechniqueFlow cytometry

FunctionLive cell analysis measuring optical light scattering to determine physical cellular characteristics and biomarkers

ApplicationsCell counts, viability, size/shape/granularity, diagnostic and prognostic monitoring (including DNA content and SPF)