Medical Policy

Effective Date:02/01/2006 Title:Flow Cytometry
Revision Date:12/01/2019 Document:BI124:00
CPT Code(s):88182; 88184-88185; 88187-88189
Public Statement

Effective Date:

a)    This policy will apply to all services performed on or after the above revision date which will become the new effective date.

b)    For all services referred to in this policy that were performed before the revision date, contact customer service for the rules that would apply.

QualChoice covers flow cytometry, a technique for determining cell markers that identify the type and origin of cancer cells. These markers help to determine prognosis and treatment.

Medical Statement
  • Scientific evidence supports the use of flow cytometry for the following specific diagnoses: HIV (B20, Z21), gastric cancer (C16.0 – C16.9), mediastinal tumors (C38.1 – C38.2), endometrial cancer (C54.1), ovarian cancer (C56.1 – C56.9), malignant neoplasm of uterine adnexa (C57.4), prostate cancer (C61), renal cancer-excluding renal pelvis (C64.1 – C64.9), cancer of the bladder (C67.0 –  C67.9), Medulloblastoma of brain for adults (C71.0 – C71.9), lymphomas, leukemias and other hematopoietic cancers (C81.00 – C86.6, C88.4 – C88.9, C90.00 – C94.42, C94.80 – C95.91, C96.0 – C96.4, C96.A – C96.9), CIS of stomach (D00.2), CIS of endometrium (D07.0), CIS of prostate (D07.5), CIS of bladder (D09.0), adult brain/cranial nerve neoplasms (D43.0 – D43.3, D49.6), polycythemia vera (D45), myelodysplastic syndromes (D46.0 – D46.9), other lymphatic/hematopoietic neoplasms (D47.0 – D47.1, D47.3 – D47.9), Monocloncal Gammopathy D47.2,

Generally, what is done in 88182 is contained in 88184 and 88185 (for the technical component) and in 88187 to 88189 (from a professional standpoint). In the instance that only a single marker is being analyzed, both the professional and technical components of the service should be represented by 88182 as a global fee or by 88182 –26 and 88182 –TC to divide the professional and technical components of the service. Further payment rules regarding flow cytometry: 

1.   Only one (1) iteration of 88184 will be paid per claim (since it is for the "first marker" and subsequent ones are billed under 88185).

2.   If 88189 is billed, neither 88187 not 88188 will pay (since, if you do 16 or more markers, that implies that the first markers are covered under that code).

3.   If 88188 is billed, 88187 will not pay (same logic)

4.   Since 88182 is covered under all of 88184 – 88189, it will pay when billed by itself (and may have both a technical and a professional component assigned to it). However, if it is billed with any of the other codes, it will not pay.

5.   88184 – 88145 are technical component only codes and may not be billed or paid with a professional component modifier.

6.   88187 – 88189 are professional component codes and may not be billed or paid with a technical component modifier.

Codes Used In This BI:

88182

Cell marker study

88184

Flow cytometry/ tc 1 marker

88185

Flow cytometry/tc add-on

88187

Flow cytometry/read 2-8

88188

Flow cytometry/read 9-15

88189

Flow cytometry/read 16 & >

Limits
Intentially left empty
Reference

Consultation with Dr Peter Pappenhausen at ESI genetic labs.

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26. Huang HY, Sung MT, Eng. HL, et al. Solitary fibrous tumor of the abdominal wall: A report of two cases immunohistochemical, flow cytometric, and ultrastructural studies and literature review. APMIS. 2002; 110(3):253-262.

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31. Shelley W, Trudeau M; Breast Cancer Disease Site Group. Adjuvant systemic therapy for node-negative breast cancer. Practice Guideline Report #1-8. Cancer Care Ontario Program in Evidence-Based Care. Toronto, ON: Cancer Care Ontario; February 2002.

32. National Health and Medical Research Council (NHMRC). Clinical Practice Guidelines: Evidence-based information and recommendations for the management of localized prostate cancer. A report of the Australian Cancer Network Working Party on Management of Localized Prostate Cancer. Canberra, ACT: AusInfo Government Info; 2003.

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37. Mesiwala AH, Scampavia LD, Rabinovitch PS, On-line flow cytometry for real-time surgical guidance. Neurosurgery. 2004; 55(3):551-560; discussion 560-561.

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Application to Products
This policy applies to all health plans administered by QualChoice, both those insured by QualChoice and those that are self-funded by the sponsoring employer, unless there is indication in this policy otherwise or a stated exclusion in your medical plan booklet. Consult the individual plan sponsor Summary Plan Description (SPD) for self-insured plans or the specific Evidence of Coverage (EOC) for those plans insured by QualChoice. In the event of a discrepancy between this policy and a self-insured customer’s SPD or the specific QualChoice EOC, the SPD or EOC, as applicable, will prevail. State and federal mandates will be followed as they apply.

Changes: QualChoice reserves the right to alter, amend, change or supplement benefit interpretations as needed.