CurrentColorado Rocky Mountain Health PlansPolicy 2026R8013A

Flow cytometry reimbursement for CMS 1500 / UB04

Defines UnitedHealthcare reimbursement methodology and limits for flow cytometry (immunophenotyping, cell enumeration, DNA analysis) billed on CMS-1500 or UB04 forms for Commercial and Individual Exchange plans; applies to all providers submitting such claims.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyFlow cytometry reimbursement for CMS 1500 / UB04

Policy CodePolicy 2026R8013A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionSubmit accurate claims using CMS-1500 or UB04 forms or electronic equivalents.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2Max specimens per DOS (88187/88188/88189)

Single unitCertain cell enumeration codes reimbursable as

Not reimbursable88182 for routine cancer management

Codes listedPrimary immunophenotyping codes referenced

MultipleAcceptable clinical indications

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.

Coverage Criteria for Flow Cytometry

Allowed indications for immunophenotyping

Reimbursement is allowed for flow cytometry immunophenotyping codes when billed for specified clinical conditions.

Covered when billed for one or more of the specific clinical conditions listed below.

ONE of

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 post-operative monitoring of individuals who will undergo or who have undergone organ transplantation.
Plasma cell disorders.
Primary immunodeficiencies (PIDs).
Primary platelet disorders, non-neoplastic.
Red cell and white cell disorders, non-neoplastic.
Malignant neoplasms.

Flow cytometry immunophenotyping codes are not reimbursed for conditions other than those listed above.

Procedure Codes and Unit Limits

Immunophenotyping procedure codesCPTCovered

88184	Flow cytometry immunophenotyping (reference)
88185	Flow cytometry immunophenotyping (unit 1)
88187	Flow cytometry immunophenotyping (unit 2)
88188	Flow cytometry immunophenotyping (unit 3)
88189	Flow cytometry immunophenotyping (unit 4)

Cell enumeration codesCPTCovered

86355	Cell enumeration - not separately reimbursable with 88xxx immunophenotyping
86356	Cell enumeration - see policy
86357	Cell enumeration - single unit only
86359	Cell enumeration - single unit only
86360	Cell enumeration - single unit only
86361	Cell enumeration - single unit only
86367	Cell enumeration - single unit only

Cell cycle/DNA analysisCPTNot Covered

88182

Flow cytometry-derived DNA content or S-phase fraction — not reimbursable for routine prognostic/therapeutic cancer management

Maximum specimens per DOS for select codes

Applicable codesCPT 88187, 88188, 88189

Maximum specimens per date of serviceUp to two specimens per date of service

Provider/facility applicabilityLimitation applies regardless of billing and/or rendering provider for each member on the same date of service

Single unit limitation

Applicable codesCPT 86355, 86357, 86359, 86360, 86361, 86367

Unit limitationReimbursable as single unit only per date of service

Claims Submission and Provider Responsibilities

Documentation Required

Claims submission responsibility

Submit accurate claims using the CMS-1500 or UB04 claim form (or their electronic equivalents). The policy is intended to ensure reimbursement based on the code(s) that correctly describe the services provided and may be applied with reasonable discretion and may vary by claims processing system.

Definitions and Unit Limits

Two specimens

DefinitionTwo specimens = Two units per procedure code

Limit per DOSCodes 88187, 88188, 88189: up to two specimens (two units) per member per date of service

Provider/facility ruleLimitation applies regardless of billing and/or rendering provider (any individual provider or any facility) for the same member and date of service

Single unit only

DefinitionSingle unit only = One unit per procedure code

Applicable codesCodes 86355, 86357, 86359, 86360, 86361, 86367

Application