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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:


Cell marker study


Flow cytometry/ tc 1 marker


Flow cytometry/tc add-on


Flow cytometry/read 2-8


Flow cytometry/read 9-15


Flow cytometry/read 16 & >


Consultation with Dr Peter Pappenhausen at ESI genetic labs.

1.    Villas BH. Flow cytometry: An overview. Cell Vis. 1998; 5(1):56-61.

2.    Gilman-Sachs A. Flow cytometry. Anal Chem. 1994; 66(13):700A-707A.

3.    Martinez JE, Beck JR, Allsbrook WC Jr., et al. Flow cytometric DNA analysis. Clin Lab Sci. 1990; 3(3):180-183.

4.    Rew DA. Clinical applications of flow cytometry. Br J Hosp. Med. 1992; 48(3-4):171-175.

5.    Byers CD. Clinical applications of flow cytometry. Clin Lab Sci. 1993; 6(3):174-176. 

6.    Jennings CD, Foon KA. Recent advances in flow cytometry: Application to the diagnosis of hematologic malignancy. Blood. 1997; 90(8):2863-2892.  

7.    Camplejohn RS. Flow cytometry. J Pathol. 1992; 166(3):323-326.  

8.    Johnson KL. Basics of flow cytometry. Clin Lab Sci. 1992; 5(1):22-24.  

9.    Goetzman EA. Flow cytometry: Basic concepts and clinical applications in immunodiagnostics. Clin Lab Sci. 1993; 6(3):177-182.  

10. Bauer KD, Bagwell CB, Giaretti W, et al. Consensus review of the clinical utility of DNA flow cytometry in colorectal cancer. Cytometry. 1993; 14:486-491.  

11. Albe X, Vassilakos P, Helfer-Guarnori K, et al. Independent prognostic value of ploidy in colorectal cancer: A prospective study using image cytometry. Cancer. 1990; 66:1168-1175.  

12. Tomoda H, Kakeji Y, Furusawa M. Prognostic significance of flow cytometric analysis of DNA content in colorectal cancer: A prospective study. J Surg Onc. 1993; 53:144-148.  

13. Silvestrini R, D`Agnano I, Faranda A, et al. Flow cytometric analysis of ploidy in colorectal cancer: A multicentric experience. Br J Cancer. 1993; 67:1042-1046.  

14. Winchester DP. Standards for diagnosis and management of invasive breast carcinoma. American College of Radiology. American College of Surgeons. College of American Pathologists. Society of Surgical Oncology. CA Cancer J Clin. 1998; 48(2):83-107.  

15. Hedley D. DNA flow cytometry and breast cancer. Breast Cancer Res Treat. 1993; 28:51-53.  

16. Pisani T, De Iorio P, Cenci M, et al. Evaluation of cellular proliferative activity and DNA ploidy as a prognostic factor in breast cancer. Minerva Ginecol. 1999; 51(1-2):1-5.  

17. Lage JM, Weinberg DS, Huettner PC, et al. Flow cytometric analysis of nuclear DNA content in ovarian tumors: Association of ploidy with tumor type, histologic grade, and clinical stage. Cancer. 1992; 69(11)2668-2675.  

18. Trope C, Kaern J. DNA ploidy in epithelial ovarian cancer: A new independent prognostic factor? Gynecol Oncol. 1994; 53:1-4. Editorial. 

19. Currin SM, Lee SE, Walther PJ. Flow cytometric assessment of deoxyribonucleic acid content in renal adenocarcinoma: Does ploidy status enhance prognostic stratification over stage alone? J Urol. 1990; 143:458-463.  

20. Jackson JF, Boyett J, Pullen J, et al. Favorable prognosis associated with hyperdiploidy in children with acute lymphocytic leukemia correlates with extra chromosome 6: A Pediatric Oncology Group study. Cancer. 1990; 66(6):1183-1189.  

21. Nativ O, Winkler HZ, and Raz Y, et al. Stage C prostatic adenocarcinoma: Flow cytometric nuclear DNA ploidy analysis. Mayo Clinic Proc. 1989; 64(8):911-919.  

22. Lee SE, Currin SM, Paulson DF, et al. Flow cytometric determination of ploidy in prostatic adenocarcinoma: A comparison with seminal vesicle involvement and histopathological grading as a predictor of clinical recurrence. J Urol. 1988; 140(4):769-774.  

23. Ritchie AW, Dorey F, Layfield LJ, et al. Relationship of DNA content to conventional prognostic factors in clinically localized carcinoma of the prostate. B J Urol. 1988; 62(3):254-260.  

24. Shearer WT, Buckley RH, Engler RJM, et al. Practice parameters for the diagnosis and management of immunodeficiency. Ann Allergy Asthma Immunol. 1996; 76(3):282-294.  

25. Bast RC Jr, Ravdin P, Hayes DF, et al. 2000 update of recommendations for the use of tumor markers in breast and colorectal cancer: Clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol. 2001; 19(6):1865-1878.

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.

27. Mirza AN, Mirza NQ, Vlastos G, Singletary SE. Prognostic factors in node-negative breast cancer: A review of studies with sample size more than 200 and follow-up more than 5 years. Ann Surg. 2002; 235(1):10-26.

28. Ottesen GL. Carcinoma in situ of the female breast. A clinico-pathological, immunohistological, and DNA ploidy study. APMIS Suppl. 2003 ;( 108):1-67.

29. Eissa S, Kassim S, El-Ahmady O. Detection of bladder tumors: Role of cytology, morphology-based assays, biochemical and molecular markers. Curr Opin Obstet Gynecol. 2003; 15(5):395-403.

30. National Health and Medical Research Council (NHMRC). Clinical Practice Guidelines: The management of cutaneous melanoma. A report of the Australian Cancer Network Working Party on Cutaneous Melanoma. Canberra, ACT: AusInfo Government Info; December 1999.

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.

33. Otchy D, Hyman NH, Simmang C, et al. Practice parameters for colon cancer. Dis Colon Rectum. 2004; 47(8):1269-1284.

34. Royal College of Obstetricians and Gynecologists (RCOG). The management of gestational trophoblastic neoplasia. Guideline No. 38. London, UK: RCOG; February 2004.

35. Elit L, Fyles A, Chambers A, et al.; Gynecology Cancer Disease Site Group. Adjuvant care for stage I ovarian cancer. Practice Guideline Report #4-13. Cancer Care Ontario Program in Evidence-Based Care. Toronto, ON: Cancer Care Ontario; May 3, 2004.

36. Habermehl P, Knuf M, Schwarz M, et al. Flow-cytometric DNA analysis of intracranial tumors in children. Pathol Res Pract. 2004; 200(3):197-202.

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.

38. Russo A, Bazan V, Migliavacca M, et al. DNA aneuploidy and high proliferative activity but not K-ras-2 mutations as independent predictors of clinical outcome in operable gastric carcinoma: Results of a 5-year Gruppo Oncologico dell`Italia Meridonale (GDIM) prospective study. Cancer. 2001; 92(2):294-302.

39. Jiao YF, Sugai T, Suzuki M, et al. Application of the crypt isolation technique to the flow cytometric analysis of DNA content in gastric carcinoma. Hum Pathol. 2004; 35(5):587-593.

40. Royal College of Obstetricians and Gynecologists (RCOG). The management of gestational trophoblastic neoplasia. London, UK: RCOG; February 2004.

41. Milligan DW, Grimwade D, Cullis JO, et al. Guidelines on the management of acute myeloid leukemia in adults. London, UK: British Society of Hematology (BSH); May 23, 2005.

42. Smith A, Wisloff F, Samson D; UK Myeloma Forum, Nordic Myeloma Study Group, British Committee for Standards in Hematology. Guidelines on the diagnosis and management of multiple myeloma 2005. Br J Haematol. 2006; 132(4):410-451.

43. Yasa MH, Bektas A, Yukselen V, et al. DNA analysis and DNA ploidy in gastric cancer and gastric precancerous lesions. Int J Clin Pract. 2005; 59(9):1029-1033.

44. Locker GY, Hamilton S, Harris J, et al. ASCO 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer. J Clin Oncol. 2006; 24(33):5313-5327.

45. Harris L, Fritsche H, Mennel R, et al; American Society of Clinical Oncology. American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer. J Clin Oncol. 2007; 25(33):5287-5312. 

46. Araujo SE, Bernardo WM, Habr-Gama A, et al. DNA ploidy status and prognosis in colorectal cancer: A meta-analysis of published data. Dis Colon Rectum. 2007; 50(11):1800-1810.

47. Wolfson AH, Winter K, Crook W, et al. Are increased tumor aneuploidy and heightened cell proliferation along with heterogeneity associated with patient outcome for carcinomas of the uterine cervix? A combined analysis of subjects treated in RTOG 9001 and a single-institution trial. Int J Radiat Oncol Biol Phys. 2008; 70(1):111-117.

48. Suehiro Y, Okada T, Okada T, et al. Aneuploidy predicts outcome in patients with endometrial carcinoma and is related to lack of CDH13 hyper methylation. Clin Cancer Res. 2008; 14(11):3354-3361.

49. Dabic MM, Nola M, Tomicic I, et al. Adenocarcinoma of the uterine cervix: Prognostic significance of clinic pathologic parameters, flow cytometry analysis and HPV infection. Acta Obstet Gynecol Scand. 2008; 87(3):366-372.

50. Ludovini V, Pistola L, Gregorc V, et al. Biological markers and DNA flow cytometric analysis in radically resected patients with non-small cell lung cancer. A study of the Perugia Multidisciplinary Team for Thoracic Tumors. Tumori. 2008; 94(3):398-405.

51. Sutcliffe P, Hummel S, Simpson E, et al. Use of classical and novel biomarkers as prognostic risk factors for localized prostate cancer: A systematic review. Health Technol Assess. 2009; 13(5):1-242.

52. Alberta Provincial Hematology Tumour Team. Lymphoma. Clinical Practice Guideline No. LYHE-002. Edmonton, AB: Alberta Health Services, Cancer Care; September 2012.

53. No authors listed. Statement on sarcoidosis. Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med. 1999; 160(2):736-755. Available at: Accessed February 19, 2015.

54. Zhang Z, Weaver DL, Munjal K, Evans MF. Intratumoral DNA content heterogeneity in breast carcinomas demonstrated by core punch tissue sampling and flow cytometry. J Clin Pathol. 2014; 67(9):821-824.

55. King TE Jr. Clinical manifestations and diagnosis of pulmonary sarcoidosis. Up-to-date Inc., Waltham, MA. Last reviewed January 2015.

56. Lu Y, Liang H, Yu T, et al. Isolation and characterization of living circulating tumor cells in patients by immunomagnetic negative enrichment coupled with flow cytometry. Cancer. 2015; 121(17):3036-3045.

57. Midthun DE. Overview of the initial evaluation, treatment and prognosis of lung cancer. Up-to-date Inc., Waltham, MA. Last reviewed January 2016.

58. National Comprehensive Cancer Network. Clinical practice guideline: Small cell lung cancer. Version 1.2016. NCCN: Fort Washington, PA.

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.
This policy has recently been updated. Please use the index above or enter policy title in search bar for the latest version.