CurrentUnitedHealthcarePolicy 2025R8213A

Flow cytometry immunophenotyping reimbursement

Defines UnitedHealthcare Medicare Advantage reimbursement rules for flow cytometry immunophenotyping (cell surface marker) procedure codes, including covered conditions, specimen/unit frequency limits, and non-separately reimbursable procedures; applies to Medicare Advantage members and providers submitting CMS 1500/UB04 claims.

Policy Summary

PayerUnitedHealthcare

PolicyFlow cytometry immunophenotyping reimbursement

Policy CodePolicy 2025R8213A

Change TypeNo material change

Effective Date12/01/2025

Next Review Date

Key ActionLimit reimbursement to two specimens per date of service for codes 88187/88188/88189 and allow single-unit reimbursement for specified cell enumeration codes.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

5procedure codes listed for immunophenotyping

2specimens reimbursable per date of service for codes 88187/88188/88189

1single unit limit per date of service for certain cell enumeration codes

11listed clinical conditions that qualify for reimbursement

Coverage Criteria for Immunophenotyping

Covered clinical indications

Reimbursement is considered for the listed immunophenotyping procedure codes when billed for any of the following conditions.

ALL of the following

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.

Policy Summary

PayerUnitedHealthcare

PolicyFlow cytometry immunophenotyping reimbursement

Policy CodePolicy 2025R8213A

Change TypeNo material change

Effective Date12/01/2025

Next Review Date

Key ActionLimit reimbursement to two specimens per date of service for codes 88187/88188/88189 and allow single-unit reimbursement for specified cell enumeration codes.

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.

Procedure Codes and Coding Rules

Flow cytometry immunophenotyping (covered)CPTCovered

88184	Flow cytometry immunophenotyping (cell surface markers)
88185	Flow cytometry immunophenotyping (cell surface markers)
88187	Flow cytometry immunophenotyping (cell surface markers)
88188	Flow cytometry immunophenotyping (cell surface markers)
88189	Flow cytometry immunophenotyping (cell surface markers)
86355	Cell enumeration — not separately reimbursable with 8818x
86356	Cell enumeration — not separately reimbursable with 8818x
86357	Cell enumeration — single unit only per date of service
86359	Cell enumeration — single unit only per date of service
86360	Cell enumeration — single unit only per date of service

1–10 of 12

1/2

Per-date-of-service specimen/unit limits

88187 / 88188 / 88189Reimbursable up to 2 specimens per date of service.

86355 / 86357 / 86359 / 86360 / 86361 / 86367Reimbursable as single unit only per date of service.

86355 / 86356 / 86357 / 86359 / 86360 / 86361 / 86367 when billed with 8818xNot separately reimbursable if billed with 88184/88185/88187/88188/88189 on the same date of service.

Applicability across providers/claimsThe two‑specimen and single‑unit limitations apply regardless of billing or rendering provider and apply whether submitted on the same or different claims for the same member/date of service.

Frequency limit scopeThe single‑unit limitation applies to each procedure code individually (i.e., counts per code, not combined).

Provider Billing and Frequency Limitations

Billing Rule

Provider billing and frequency limitations — key rules

Reimbursement is allowed for listed immunophenotyping procedure codes when billed for specified conditions. Note the specimen and unit frequency limits below and follow billing rules to avoid denials.

Procedure codes 88187, 88188, and 88189 are reimbursable up to two specimens per date of service.
The two‑specimen/units per procedure code limitation applies regardless of billing and/or rendering provider — i.e., it is per individual member per date of service across any provider or facility.
Procedure codes 86355, 86356, 86357, 86359, 86360, 86361, and 86367 may be submitted on the same or a different claim; the specimen/unit limits still apply per member per date of service regardless of claim or provider.
Any single‑unit limitations referenced are also applicable regardless of billing and/or rendering provider and are assessed per member per date of service.
Frequency limitations apply to each procedure code individually (limits are per code, not aggregated across different codes).

Definitions

Flow cytometry immunophenotyping — definition

Procedure descriptionFlow cytometry immunophenotyping is analysis of cell surface markers using flow cytometry to characterize and enumerate cell populations.

PurposeUsed to evaluate hematologic and immunologic conditions such as cytopenias, lymphomas, leukemias, myeloproliferative/lymphoproliferative disorders, primary immunodeficiencies, and transplant monitoring.

MethodIdentifies cell populations by labeling surface markers with fluorochrome‑conjugated antibodies and measuring light scatter and fluorescence as cells pass through a laser beam in a flow cytometer.

Billing contextSpecific CPT procedure codes for flow cytometry immunophenotyping (e.g., 88184–88189) are subject to coverage criteria and frequency limitations per policy.