2025 CPT code 89240
(Active) Effective Date: N/A Pathology and Laboratory - Other Pathology and Laboratory Procedures Pathology and Laboratory Feed
Unlisted miscellaneous pathology test.
Modifiers may be applicable depending on the specific circumstances of the procedure.Refer to modifier guidelines and payer policies for appropriate usage.
Medical necessity must be clearly documented and justified in the accompanying documentation.The rationale for using this unlisted code should also be explained due to the potential for payer scrutiny.
The provider performs a pathology procedure not represented by a standard CPT code. They are responsible for ensuring accurate documentation and justification for the use of this unlisted code.
- Pathology and Laboratory
- Pathology and Laboratory Procedures > Other Pathology and Laboratory Procedures
In simple words: This code is used for lab tests that don't have their own specific code.Your doctor will use this if there's no other way to bill for the exact test you needed.
This code is used for pathology procedures that do not have a specific CPT code. It's essential to use this code only when no other appropriate code exists, including Category III codes. When billing with this code, provide a cover letter explaining the procedure and its medical necessity, along with supporting documentation.
Example 1: A patient presents with unusual symptoms, and a novel diagnostic test is developed and performed, requiring the use of 89240 due to the absence of a specific code., A research study necessitates a unique laboratory analysis not covered by existing CPT codes, leading to the use of 89240 for billing purposes., A complex or specialized test is performed for which a specific CPT code is unavailable, necessitating the application of 89240.
Detailed operative notes or relevant clinical documentation explaining the procedure. Comparison of the procedure to similar existing CPT codes. Justification for the use of the unlisted code and the billed amount. Supporting evidence of medical necessity.
- Revenue Code: T1G - LAB TESTS - OTHER (MEDICARE FEE SCHEDULE)
- Payment Status: Active
- Specialties:Pathology
- Place of Service:Independent Laboratory, Office