Hematology - CPT Codes FAQ for Laboratorians

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Is there a CPT® code or reimbursement available for the automated Immature Granulocyte (IG) count?
No, the automated IG count is part of the routine automated WBC differential so no additional CPT code or reimbursement is available. However, there may be operational benefits to reporting out the automated IG count.

Is there a CPT Code or reimbursement available forthe Reticulocyte Hemoglobin (RET-He) or Immature Platelet Fraction (IPF)?
A specific CPT code has not been assigned to Reticulocyte Hemoglobin. There is a CPT code for the reticulocyte count (85045) and a separate code for a reticulocyte count + 1 additional retic parameter, which can be either the IRF or RET-He (85046). Only one of these two Retic codes is allowed per patient. There is also a CPT code that can be used for the IPF parameter-85055. All billing and reimbursement decisions should be made in conjunction with your coding and billing departments.

Parameters
IG
Centers for Medicare & Medicaid Services, CMS.gov
None
Description
6-Part differential

Parameters
IPF
Centers for Medicare & Medicaid Services, CMS.gov
85055
Description
Immature platelet count

Parameters
RET-He
Centers for Medicare & Medicaid Services, CMS.gov
85046*
Description
Reticulocyte count +1 parameter

Parameters
Retic #/%
Centers for Medicare & Medicaid Services, CMS.gov
85045*
Description
Reticulocyte count only

* Only one CPT code submission is allowed per patient

Note: This information is provided as a courtesy for informational purposes only and is not intended to be, and should not be interpreted as, reimbursement or billing advice. Health care professionals are responsible for determining appropriate reimbursement policies, including applicable CPT code assignment. Sysmex America, Inc., does not guarantee third-party coverage or payment for products or provide remuneration to customers for claims that are denied by third-party payers.

Reimbursement Data for Laboratorians: Advanced Clinical Parameters (ACP)
The Centers for Medicare & Medicaid Services (CMS) published the Protecting Access to Medicare Act (PAMA) in 2014 and the corresponding Clinical Laboratory Fee Schedule (CLFS). For more information on PAMA and the new CLFS rates please visit: https://www.cms.gov/medicare/payment/fee-schedules/ clinical-laboratory-fee-schedule-clfs/files

Note: This information is provided as a courtesy for informational purposes only and is not intended to be, and should not be interpreted as, reimbursement or billing advice. Health care professionals are responsible for determining appropriate reimbursement policies, including applicable CPT code assignment. Sysmex America, Inc., does not guarantee thirdparty coverage or payment for products or provide remuneration to customers for claims that are denied by third-party payers.

 

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