2025 CPT code 86152
(Active) Effective Date: N/A Revision Date: N/A Laboratory - Immunology Procedures Pathology and Laboratory Procedures Feed
Cell enumeration using immunologic selection and identification in fluid specimen (e.g., circulating tumor cells in blood).
Modifiers may be applicable depending on the circumstances of service.Consult your specific payer guidelines for modifier usage.
Medical necessity for this test is determined based on the clinical indication and the patient's condition.This test is usually medically necessary in the context of cancer management to monitor disease progression, assess treatment response, or predict prognosis.Payers may have specific guidelines and requirements for medical necessity documentation.
The clinical responsibility lies with the laboratory analyst who performs the technical aspects of the test, including specimen preparation, using specialized reagents and equipment to identify and quantify the target cells. A pathologist may be responsible for the interpretation and report generation (coded separately).
In simple words: This lab test counts specific types of cells in a body fluid sample (like blood), such as cancer cells.The lab uses special techniques to find and count these cells, which are usually present in very small numbers. The test helps doctors make treatment plans and check how well the treatment is working.
This CPT code represents the technical component of cell enumeration using immunologic selection and identification methods in a fluid specimen.The procedure involves preparing the specimen (e.g., blood), using special reagents and analyzers to identify and quantify specific cells, such as circulating tumor cells (CTCs), which are present in very low concentrations.Methods may include magnetic nanoparticle separation, microfluidic separation, or filter-based methods.This code does not include the professional component (physician interpretation and report); for that, code 86153 should be reported separately.Clinicians may order this test for prognostic and treatment management purposes in various cancers (e.g., breast, colon).
Example 1: A patient with suspected metastatic breast cancer undergoes a blood test to detect circulating tumor cells (CTCs).The lab uses a microfluidic device to isolate and count the CTCs, reporting the results using CPT code 86152. A pathologist reviews the results and generates a report using CPT code 86153., A patient with colon cancer is monitored for recurrence using periodic blood tests for CTCs. The laboratory uses magnetic bead separation to isolate CTCs before quantification and reporting the result with CPT code 86152. No separate pathologist report is needed in this case., A research study is evaluating a new method for CTC detection.The lab uses a novel filter-based technique to isolate and quantify CTCs from blood samples. The results are reported using CPT code 86152, with separate billing for the pathologist's interpretation and report (CPT code 86153).
* Patient demographics and relevant medical history.* Date and time of specimen collection.* Type and volume of specimen collected.* Method used for cell enumeration.* Detailed results of the cell enumeration, including the number of cells identified and quantified.* Any relevant images or microscopic findings.* Clinician's order specifying the test requested.* If applicable, documentation supporting medical necessity.
** This code is for cell enumeration using immunologic methods, not for other types of cell counts or analyses. Always refer to the most up-to-date CPT manual for accurate coding.
- Revenue Code: T1H (LAB TESTS - OTHER (NON-MEDICARE FEE SCHEDULE))
- Payment Status: Active
- Modifier TC rule: This code represents the technical component (TC).The professional component (PC) is reported separately using code 86153.
- Specialties:Oncology, Hematology, Pathology
- Place of Service:Office, Hospital (Inpatient/Outpatient), Laboratory