2025 CPT code 86153
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Pathology and Laboratory Procedures - Qualitative or Semiquantitative Immunoassays Immunology Procedures Feed
Physician interpretation and report of cell enumeration using immunologic selection and identification in a fluid specimen (e.g., circulating tumor cells in blood).
Modifier 26 (professional component) is typically required by Medicare for CPT code 86153. Other modifiers may be appropriate depending on the circumstances of service.
Medical necessity is established when the ordering physician has a clinical indication suggesting the need for the testing, such as evaluating the presence and quantification of CTCs for prognosis or treatment management in patients with suspected or confirmed metastatic cancers.
The pathologist reviews the results of the cell enumeration test (CPT 86152), interprets the findings, correlates them with the patient's clinical history and other diagnostic information, and prepares a written report for the ordering physician.This report may include cell counts, identification of specific cell types, and clinical implications.
In simple words: This code covers the doctor's work in reviewing and explaining the results of a lab test that counts specific types of cells in a body fluid sample (like blood).The doctor analyzes the results and writes a report to help with diagnosis and treatment.
This CPT code reports the professional component of a cell enumeration procedure using immunologic selection and identification methods performed on a fluid specimen, such as circulating tumor cells (CTCs) in blood.The physician, typically a pathologist, interprets the results of the technical component (CPT code 86152) and generates a comprehensive report. This interpretation includes analysis of the enumerated cells, their identification, and clinical significance.The report provides valuable insights for diagnosis, prognosis, treatment monitoring, and disease management.
Example 1: A patient with suspected metastatic breast cancer undergoes a CTC (circulating tumor cell) blood test (CPT 86152). A pathologist reviews the results, identifies the number and type of CTCs present, and writes a report for the oncologist, detailing the findings and their implications for treatment planning (CPT 86153)., A patient with colon cancer is undergoing monitoring for recurrence.A CTC blood test is performed (CPT 86152), and the pathologist's review and interpretation of the results (CPT 86153) helps to assess disease progression and guide adjustments to the patient's treatment regimen., In a research setting, a novel method for CTC enumeration is tested. After the technical component, a pathologist interprets the results (CPT 86153) to validate the new method's accuracy and efficiency in identifying specific cell populations.
* Patient demographics and relevant clinical history.* Test requisition with the specific reason for the test.* Complete results of the technical component (CPT 86152), including all relevant data generated during the testing process.* Pathologist's interpretation and report, including the number and type of cells identified and clinical implications.* Supporting documentation, such as imaging studies or other laboratory results that may help in interpreting the results.
** This code is specifically for the physician interpretation and report.The technical component of the test is reported separately using CPT code 86152.Always consult current CPT guidelines and payer-specific policies for accurate coding and reimbursement.
- Revenue Code: T1H (LAB TESTS - OTHER (NON-MEDICARE FEE SCHEDULE))
- RVU: Information not available in provided sources.RVUs vary based on geographic location and payer.
- Global Days : Not applicable. This is a professional interpretation service, not a surgical procedure.
- Payment Status: Active
- Modifier TC rule: Modifier 26 indicates the professional component.Modifier TC (Technical Component) applies to code 86152.
- Fee Schedule : Information not available in provided sources.Consult payer-specific fee schedules.
- Specialties:Pathology, Oncology, Hematology
- Place of Service:Office, Hospital (Inpatient/Outpatient), Clinical Laboratory