2025 CPT code 99195
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Medicine - Other Medicine Services and Procedures Medicine Services and Procedures Feed
Therapeutic phlebotomy (removal of blood to treat a medical condition).
Modifiers may be applicable depending on the circumstances.Consult the CPT manual and payer-specific guidelines for clarification.
Therapeutic phlebotomy is medically necessary when performed to treat specific conditions, such as polycythemia vera, hemochromatosis, or hyperkalemia.The procedure must be supported by appropriate clinical documentation and ordered by a physician.
The physician or qualified healthcare professional is responsible for determining the medical necessity of the therapeutic phlebotomy, determining the amount of blood to be removed, performing the venipuncture, and monitoring the patient's response to the procedure. Post-procedure care, including fluid replacement, may also fall under the physician's responsibility.
In simple words: This medical procedure removes some blood from a patient to treat a specific health problem, such as having too many red blood cells or too much iron in their blood.It's like a blood donation but done for medical reasons.
Therapeutic phlebotomy involves the removal of a specified amount of venous blood from a patient to treat conditions such as polycythemia vera, hemochromatosis, or hyperkalemia.The procedure typically involves venipuncture, with the amount of blood removed determined by the patient's clinical needs and monitored by laboratory tests.Post-phlebotomy, intravenous fluids may be administered to manage fluid balance. This procedure is distinct from routine venipuncture for laboratory testing.
Example 1: A patient with polycythemia vera (a blood disorder characterized by an excess of red blood cells) undergoes therapeutic phlebotomy to reduce their red blood cell count and viscosity, thus reducing the risk of thrombosis., A patient with hemochromatosis (an iron overload disorder) receives regular therapeutic phlebotomies to remove excess iron from their blood, preventing organ damage., A patient with severe hyperkalemia (high potassium levels in the blood) undergoes a therapeutic phlebotomy to lower their potassium levels, a critical intervention in the event of potentially life-threatening cardiac arrhythmias.
* Physician's order specifying the amount of blood to be removed.* Patient's medical history, including relevant diagnosis.* Pre-procedure and post-procedure vital signs.* Documentation of the amount of blood removed.* Hemoglobin and hematocrit levels pre and post-procedure (ideally within 48 hours).* Informed consent.* Any administered intravenous fluids and their volume.
** Always verify payer-specific guidelines and policies before submitting claims for 99195.Incorrect coding can lead to claim denials.If the phlebotomy is performed as part of a larger procedure, it might be included in the global surgical period of another procedure and not separately billable.
- Revenue Code: P6C (MINOR PROCEDURES - OTHER)
- RVU: This information is not available in the provided source.RVUs vary based on geographic location and payer.
- Global Days: Not applicable.This is not a surgical procedure.
- Payment Status: Active (payment subject to medical necessity and proper coding)
- Modifier TC rule: Not applicable.The entire service is performed by the physician.
- Fee Schedule: This information varies based on location, payer and year.Consult historical fee schedules for specific information.
- Specialties:Hematology, Oncology, Internal Medicine
- Place of Service:Office, Hospital Inpatient, Hospital Outpatient