2025 CPT code 84999
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Laboratory - Chemistry Procedures Pathology and Laboratory Procedures Feed
Unlisted chemistry procedure; use only when no other specific CPT code exists.
Modifiers may apply depending on the specific circumstances of the service. For example, modifiers may be used to indicate the place of service or the type of service provided.
Medical necessity must be established for the unlisted chemistry procedure.This typically involves demonstrating that the test is necessary for the diagnosis or treatment of the patient's condition and that no other existing test can provide the required information.
The clinical responsibility lies with the physician ordering the test and the laboratory personnel performing and interpreting the results.
- Pathology and Laboratory Procedures
- 84999 falls under the Chemistry Procedures subcategory within the Pathology and Laboratory Procedures section of CPT codes.
In simple words: This code is for a blood or urine test that doesn't have its own specific code.Doctors use it only when a standard test isn't available to describe what they did. They must explain exactly what test was performed to get paid.
This CPT code, 84999, represents an unlisted chemistry procedure.It should only be used when a definitive chemistry test is performed and no other specific CPT code accurately reflects the service provided.The code is not intended for use as an approximation of existing codes.When using this code, detailed documentation justifying the selection of 84999 over any other appropriate code is required for claim submission.
Example 1: A new, experimental assay is developed to measure a novel biomarker for a specific disease. Since there is no existing CPT code, 84999 is used, along with comprehensive documentation detailing the methodology, results, and clinical relevance., A patient presents with symptoms suggestive of a rare metabolic disorder.The physician orders a specialized chemistry panel analyzing specific metabolites not included in standard panels.Because no individual codes cover these metabolites, 84999 is used, with detailed descriptions of each analyte measured and the analytical methods employed., A research study requires measuring a novel compound in patient samples. There are no existing codes for this novel analyte.After a thorough literature search and review of existing codes fails to find any suitable existing test, the researchers appropriately use 84999 to bill for the test. A detailed explanation of the methodology is provided in their submission.
*Detailed description of the performed test, including methodology, reagents used, and quality control measures.*Results of the test.*Reason for choosing code 84999 over other specific codes.*Comparison to similar codes, justifying the billed amount.*Physician's order specifying the required test.
** When submitting a claim with 84999, it is essential to provide detailed documentation to support medical necessity and justify the charge. Failure to do so may result in claim denial.Payers often review claims with unlisted procedure codes on a case-by-case basis.It is beneficial to include references to similar codes to aid in evaluating the appropriateness of the charge.
- Revenue Code: T1H (LAB TESTS - OTHER (NON-MEDICARE FEE SCHEDULE))
- RVU: The relative value units for 84999 will vary significantly depending on the specific unlisted procedure performed and the payer.It cannot be determined without further information regarding the specific test performed.Proper documentation is crucial for reimbursement.
- Global Days: Not applicable. This code represents a laboratory procedure, not a surgical procedure.
- Payment Status: Active
- Modifier TC rule: Technical Component (TC) modifiers are not applicable to this code as it is an unlisted procedure code and represents a complete service.
- Fee Schedule: Historical fee schedules for 84999 are not consistently available due to the nature of the unlisted code. Payment will be determined based on the documentation provided and payer-specific policies.
- Specialties:Clinical Chemistry, Pathology, and any specialty requiring specialized, unlisted chemistry analyses.
- Place of Service:Office, Hospital (Inpatient and Outpatient), Clinical Laboratory