Currentpriority healthPolicy N/A

Flow cytometry reimbursement and billing requirements

Governs payment, coding, documentation, and place-of-service considerations for flow cytometry laboratory services for Priority Health members and providers submitting claims to Priority Health.

Policy Summary

Payerpriority health

PolicyFlow cytometry reimbursement and billing requirements

Policy CodePolicy N/A

Change TypeDefinition added

Effective DateN/A

Next Review DateApr 1, 2026

Key ActionObtain a Pre-Service Organization Determination (PSOD) for Medicare indications not covered by NCD/LCD or specific medical policy; authorization may be required depending on setting and member needs.

SourceLink

POLICY UPDATE CHANGES

Flow cytometry definition added to the Definition part of policy.

up to 288184 units

up to 3588185 units

1 unit/specimen88187-88189 limit

single unitCell enumeration

Flow Cytometry Coverage and Billing Rules

Policy Summary

Payerpriority health

PolicyFlow cytometry reimbursement and billing requirements

Policy CodePolicy N/A

Change TypeDefinition added

Effective DateN/A

Next Review DateApr 1, 2026

SourceLink

On This Page

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.

Use CPT code 88184 for the first marker per specimen; reimbursable up to a maximum of 2 units per date of service.

Use CPT code 88185 for each additional marker; reimbursable up to a maximum of 35 units per date of service.

Do not report CPT codes 88187, 88188, and 88189 together for a single specimen in any combination.

CPT codes 88187, 88188, and 88189 are reimbursed at 1 unit per specimen, up to 2 specimens per date of service.

Do not report CPT codes 88187-88189 in conjunction with cell enumeration codes 86355, 86356, 86357, 86359, 86360, 86361, or 86367.

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

Place of service: Coverage will be considered when services are furnished in the appropriate setting to the patient's medical needs and condition; authorization may be required.

Documentation requirement: Complete and thorough documentation to substantiate the procedure performed is the provider's responsibility; consult any specific documentation requirements in applicable guidelines.

Modifiers and coding guidance: Follow CMS NCCI and standard billing/coding guidelines; apply modifiers only when supported by documentation.

Enforcement and reviews

Failure to follow government/regulatory or policy guidelines may result in claim rejection or denial, recovery/recoupment of payments, or denial despite authorization on file.
Payment integrity pre- or post-claim reviews may be performed to validate billing and coding accuracy and to prevent fraud, waste, and abuse.

Billing requirements: Use industry-standard CPT/HCPCS and revenue codes only when the service has been performed and fully documented to the highest level of specificity; an authorization does not supersede coding, billing, or reimbursement requirements.

CPT/HCPCS Codes and Unit Limits

Flow cytometry CPT/HCPCS guidancemixedCovered

88184	First marker per specimen; reimbursable up to a maximum of two units per date of service
88185	Each additional marker; reimbursable up to a maximum of 35 units per date of service
88187	Flow cytometry code; reimbursed at one unit per specimen, up to two specimens per date of service; not to be used with 88188/88189 for same specimen
88188	Flow cytometry code; reimbursed at one unit per specimen, up to two specimens per date of service; not to be used with 88187/88189 for same specimen
88189	Flow cytometry code; reimbursed at one unit per specimen, up to two specimens per date of service; not to be used with 88187/88188 for same specimen
86355	Cell enumeration; reimbursable as single unit only
86356	Cell enumeration; (listed in policy as not to be used in conjunction with 88187-88189)
86357	Cell enumeration; reimbursable as single unit only
86359	Cell enumeration; reimbursable as single unit only
86360	Cell enumeration; reimbursable as single unit only

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inv-03: Max units for 88185 — per-date-of-service limit

Max units per date of serviceCode 88185 reimbursable up to a maximum of 35 units per date of service

Related first-marker ruleCode 88184 is used for the first marker per specimen and reimbursable up to 2 units per date of service

Unit contextLimit applies to each date of service (aggregate across specimens/services on that date)

Authorization and Pre-Service Requirements

Prior Authorization

Prior Authorization / Pre-Service Organization Determination Required

For Medicare indications that do not meet criteria in a National Coverage Determination (NCD), Local Coverage Determination (LCD), or a specific Priority Health medical policy, a Pre-Service Organization Determination (PSOD) is required prior to providing services. Providers must submit a PSOD using the processes described in the Priority Health Provider Manual. Services must be furnished in an appropriate place of service based on the patient’s medical needs and condition; authorization may be required for services in any setting. Failure to obtain a required PSOD or authorization may result in denial of payment.

PSOD required when Medicare indication is not covered by NCD/LCD or another Priority Health medical policy
Follow submission and documentation steps in the Priority Health Provider Manual
Authorization may be required depending on place of service and clinical circumstances
Services without required PSOD/authorization may be denied

Definitions

inv-05: Flow cytometry — method and key terms

DefinitionFlow cytometry is a laboratory method that rapidly examines individual cells or particles as they pass in a liquid stream through laser light, assessing cell size, structural complexity, and fluorescently labeled markers

FunctionOperates like a fast microscope to count and distinguish cell populations in suspension

Key componentsUses a liquid stream, laser light, and fluorescent labels to evaluate and differentiate cells