86053
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Claims must include the appropriate CPT code, 1 unit of service (UOS), and the appropriate ICD-10-CM diagnosis code.
- Additional medical necessity documentation must be submitted when more than 24 markers are tested.
- Follow the associated Local Coverage Determination LCD L34215 for full documentation and coverage requirements not detailed here.
- The FCM report must document the specific clinical indication for each marker that exceeds the 24-marker panel limit; lack of specific indication for each additional marker will result in claim denial.
Key Coverage Criteria
- Flow cytometry is covered for examination of body fluids (including peripheral blood and cerebrospinal fluid), bone marrow, and lymphoreticular tissues (lymph nodes, tonsil, spleen).
- Peripheral blood and fine needle aspirate specimens are acceptable for flow cytometry to avoid more invasive diagnostic procedures.
- Coverage decisions are governed by the associated Local Coverage Determination LCD L34215 and its specific coverage criteria.
- FCM is indicated to evaluate blood, body fluids, CSF, bone marrow, lymph node, tonsil, spleen and other solid tissues for characterization of cellular populations and to avoid more invasive procedures when peripheral blood or fine needle aspirate material suffices.
- FCM is indicated for evaluation of unexplained cytopenias or hypercellular hematolymphoid disorders when preliminary medical review and laboratory testing do not reveal a cause and bone marrow aspiration/biopsy is performed to rule out infiltrative or stem cell disorders.
- FCM immunophenotyping is indicated as part of the initial diagnostic workup for suspected non-Hodgkin lymphoma to identify abnormal B-cell, T-cell and/or NK-cell populations using a standard lymphoma panel.
3 Active Policies
A57689 — Billing and Coding: Lab: Flow Cytometry
L34215 — Lab: Flow Cytometry
A57690 — Billing and Coding: Lab: Flow Cytometry
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.