LabCorp changed CPT Code for NK Cell Functional Assay Testing

Blog entry posted by NVCFS2005, Oct 29, 2013.

Has anyone noticed that LabCorp changed their billing codes and charges for the Natural Killer Cell Functional Assay Testing at some point between July and September 2012?

In my situation it was changed from CPT code 88184 (x1) and CPT 88185 (x2), which is the industry standard coding for this type of Flow Cytometry testing, to CPT code 86849 Unlisted Immunology Procedure. Under the terms of my health plan, successful use of the unlisted procedure coding permits LabCorp to bill a larger amount, incur a smaller contractual discount amount as a preferred provider and consequently receive larger reimbursement payments from both the health plan and the insured.

My health plan has denied payment because unlisted codes, like CPT code 86849 can only be used when there is no other specific CPT code to describe the procedure. This result is the product of numerous appeals I have filed. The CPT codes LabCorp used prior to September 2012 are still approved by the AMA and available for LabCorp's use. Yet as of September 2013, LabCorp insists on using the unlisted procedure CT code 86849.

Is anyone else having trouble getting their insurance to pay on this lab test because of this change in CPT coding when there was no problem before September 2012? If so, please provide the details of your circumstances, thank you.
SunMoonsStars likes this.
  1. NVCFS2005
    Still looking for people who are not getting insurance coverage for the Natural Killer Cell Functional Assay (NK Cell Cytotoxicity) if the lab processing the test is LabCorp.
  2. Izola
    I'm Izola, the newbie kid on the block and I'm telling you, you all are a whole lot more sophisticated than I am in dealing with a doctor. Mine wouldn't even order the test. By the time I get to the office, I'm ready to collapse. No oomph to coax and cajole. I don't even know if she really knew, or knows how very sick I am, at least until I passed out in Walgreens while picking up my
  3. NVCFS2005
    The test we are referring to is Natural Killer Cell Functional Assay or NK Cell Cytotoxicity. The result is one number measured in lytic units with a reference range of 5.8 - 59.2 LU10.

    LabCorp has not be responsive to our requests for details and documentation relating to this change. According to our insurance company, LabCorp told them the AMA directed them to change their internal codes and when that happened the CPT codes 88184 and 88185 were no longer available to them. Since the labs that perform this test (Viracor IBT, Quest, Focus) still list on their web sites that 88184 and 88185 are the CPT codes to be used, we do not believe this to be true and continue with the appeal process.
  4. acer2000
    Yes! I have been trying to get to the bottom of this. My plan also denied payment for this test and I have to appeal. I noticed that they changed the code in Sept 2012 as well. I found it very odd that my medicare EOB had such a non-specific code for this test. FYI - they paid for it last year, July 2012 prior to the code change. Here is my post on the same issue:

    Here is my thread about the same issue:
    SunMoonsStars likes this.
  5. roxie60
    Are you referring to the various CD tests (CD4, CD8, CD56, CD57)?