2025 CPT code 86361
(Active) Effective Date: N/A Revision Date: N/A Laboratory - Immunology Procedures Pathology and Laboratory Procedures Feed
Absolute CD4 T-cell count; measures the number of CD4 cells in a blood sample, typically used to assess immune system strength, especially in HIV patients.
Modifiers may apply depending on the circumstances of service delivery. For example, modifier 90 might be appended if the test was performed by an outside laboratory.
Medical necessity is established based on the patient's clinical presentation, risk factors, and diagnosis (e.g., HIV, immunosuppression). The test is medically necessary to monitor immune function, assess the effectiveness of treatment, and guide clinical management decisions. Payer-specific medical necessity policies may apply.
The clinical responsibility lies with the laboratory analyst who performs the test, analyzes the results, and reports the findings. The ordering physician interprets these results in the context of the patient's clinical presentation and medical history.
In simple words: This blood test counts the number of CD4 cells, a type of white blood cell that fights infection.A low count means your immune system is weak and you're more likely to get sick, especially if you have HIV.
This CPT code, 86361, represents an absolute CD4 T-cell count, a laboratory procedure quantifying the number of CD4+ T lymphocytes (a type of white blood cell crucial for immune function) per microliter of a patient's blood sample.The test is performed using flow cytometry, a technique that identifies and counts cells based on their surface markers.The results are reported as the number of CD4 cells per cubic millimeter or microliter.A normal range is typically between 600 and 1200 cells per cubic millimeter.Counts below 200 indicate a significantly weakened immune system and high risk of opportunistic infections, particularly relevant in HIV infection. The clinical interpretation involves comparing the patient's result to the established reference range and evaluating the significance based on clinical context.
Example 1: A 35-year-old male with a known HIV diagnosis presents for routine monitoring. His CD4 count is ordered to assess the effectiveness of his antiretroviral therapy. A count below 200 would trigger immediate changes to treatment strategy and prophylaxis against opportunistic infections., A 40-year-old female is experiencing recurrent infections and fatigue. Her physician suspects HIV and orders a CD4 count as part of the diagnostic workup. A low CD4 count would support the HIV diagnosis., A 28-year-old male on long-term immunosuppressive therapy after an organ transplant has a low CD4 count.This necessitates close monitoring for opportunistic infections and adjustments in their immunosuppression regimen.
* Patient demographics and unique identifiers.* Date and time of specimen collection.* Method of specimen collection (e.g., venipuncture).* Type of specimen (e.g., whole blood).* Test results with units of measurement (cells/µL or cells/mm³).* Date and time the results were reported.* Clinician's interpretation of the results and clinical significance.* Supporting clinical documentation (e.g., patient history, physical examination findings, other relevant lab results)
** The normal CD4 count range can vary slightly depending on the laboratory's specific methods and reference ranges. Always consult the laboratory's reference range for interpretation. This test is a vital component in the management of HIV infection, providing critical information for treatment decisions and monitoring disease progression.
- Revenue Code: T1H (LAB TESTS - OTHER (NON-MEDICARE FEE SCHEDULE))
- RVU: Not specified in provided data.Consult the current year's Medicare Physician Fee Schedule or other relevant payer's fee schedule for RVU values.
- Global Days: Not applicable; this is a laboratory test, not a surgical procedure.
- Payment Status: Active
- Modifier TC rule: Not applicable; this code represents the complete procedure.
- Fee Schedule: Fee schedules vary by payer and year. Consult relevant fee schedules for historical data.
- Specialties:Infectious Disease, Hematology, Immunology, Internal Medicine
- Place of Service:Office, Hospital (Inpatient/Outpatient), Laboratory