2025 CPT code 86999
(Active) Effective Date: N/A Pathology and Laboratory Procedures > Transfusion Medicine Procedures Feed
Unlisted transfusion medicine procedure.
Modifiers may be applicable depending on the specific circumstances of the procedure and should be used in accordance with coding guidelines.
Medical necessity must be clearly documented, linking the unique transfusion medicine procedure to the patient's specific clinical condition and treatment plan.
The analyst performs a transfusion medicine procedure not represented by any standard, active CPT code.
In simple words: This code is used when a lab test relating to blood transfusions is performed that doesn't have its own specific code.
This code is used to report transfusion medicine analytes/procedures that are not otherwise specified in CPT codes 86850-86985, and are not found within the Chemistry (82009-84830) or Immunology (86015-86835) subsections.Apheresis (36511, 36512) and therapeutic phlebotomy (99195) should not be reported with this code.
Example 1: A patient requires a specialized blood compatibility test not routinely performed, requiring unique processing and analysis not covered by existing codes., A new method for platelet antigen typing is developed and used for a patient, requiring use of the unlisted code until a specific code is established., A complex investigation of a transfusion reaction involves several specialized tests beyond the scope of existing codes, necessitating the use of 86999.
Detailed description of the procedure performed.Rationale for why existing codes are not applicable.Supporting clinical documentation justifying the medical necessity of the procedure.Comparison to similar procedures with established CPT codes for valuation purposes.
** Claims submitted with this code are subject to payer review and may require additional documentation for reimbursement. Payment is determined on a case-by-case basis depending on the documentation provided. Be sure to consult iFrameAI for the most current and complete information.
- Revenue Code: T1H - LAB TESTS - OTHER (NON-MEDICARE FEE SCHEDULE)
- Specialties:PathologyHematologyBlood Banking/Transfusion Medicine
- Place of Service:Independent LaboratoryOutpatient HospitalInpatient Hospital