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Official Description

Bilirubin; direct

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The CPT® Code 82248 refers to a laboratory test specifically designed to measure direct bilirubin levels in the blood. Bilirubin is a yellowish pigment that is produced during the normal breakdown of red blood cells (RBCs). When RBCs are destroyed, hemoglobin is released and subsequently metabolized into bilirubin. This process results in two forms of bilirubin: unconjugated (non-water soluble) and conjugated (direct). Unconjugated bilirubin is transported to the liver bound to albumin, where it undergoes a transformation to become conjugated by attaching to sugar molecules, thus becoming water soluble. This conjugated form, known as direct bilirubin, can then be excreted from the liver into the small intestine, where it is further processed and ultimately eliminated from the body in feces as stercobilin. The total bilirubin level in the blood is the aggregate of both conjugated (direct) and unconjugated bilirubin. Testing for direct bilirubin, as indicated by CPT® Code 82248, is crucial for diagnosing and monitoring various medical conditions, including liver disorders, hemolytic anemia, and physiological jaundice in newborns. The test is typically performed on a blood sample, which can be obtained through venipuncture or heel stick in infants. Additionally, other bodily fluids, such as cerebrospinal fluid, may also be collected for total bilirubin testing. The analysis of serum and/or plasma is conducted using quantitative spectrophotometry, a method that measures the concentration of bilirubin in the sample.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The test for direct bilirubin (CPT® Code 82248) is indicated for several clinical scenarios, particularly when there is a need to assess liver function or investigate specific medical conditions. The following are the primary indications for performing this test:

  • Liver Disorders The measurement of direct bilirubin is essential in diagnosing and monitoring liver diseases, as elevated levels may indicate liver dysfunction or biliary obstruction.
  • Hemolytic Anemia In cases of hemolytic anemia, where there is increased destruction of red blood cells, direct bilirubin levels may rise due to the liver's processing of the excess bilirubin produced from the breakdown of RBCs.
  • Newborn (Physiologic) Jaundice This test is commonly ordered for newborns to evaluate jaundice, a condition characterized by yellowing of the skin and eyes, which can occur due to elevated bilirubin levels shortly after birth.

2. Procedure

The procedure for obtaining a direct bilirubin test involves several key steps, ensuring accurate collection and analysis of the blood sample. The following outlines the procedural steps:

  • Step 1: Sample Collection A blood sample is obtained from the patient, which can be done through venipuncture or, in the case of infants, a heel stick. Proper technique is essential to minimize discomfort and ensure an adequate sample volume for testing.
  • Step 2: Sample Handling Once collected, the blood sample is processed to separate the serum or plasma from the cellular components. This step is crucial as it prepares the sample for accurate measurement of bilirubin levels.
  • Step 3: Testing Methodology The serum or plasma is then subjected to quantitative spectrophotometry, a laboratory technique that measures the concentration of direct bilirubin in the sample. This method relies on the absorption of light at specific wavelengths by bilirubin, allowing for precise quantification.

3. Post-Procedure

After the direct bilirubin test is completed, the laboratory will analyze the results and report the direct bilirubin levels. Depending on the findings, further evaluation or additional testing may be warranted to determine the underlying cause of any abnormalities. Patients may be advised to follow up with their healthcare provider to discuss the results and any necessary next steps. It is important to monitor bilirubin levels, especially in newborns, to prevent complications associated with high bilirubin levels, such as kernicterus. No specific post-procedure care is typically required for the patient following a blood draw, although they should be informed about potential minor side effects, such as bruising or discomfort at the puncture site.

Short Descr BILIRUBIN DIRECT
Medium Descr BILIRUBIN DIRECT
Long Descr Bilirubin; direct
Status Code Statutory Exclusion (from MPFS, may be paid under other methodologies)
Global Days XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC) 9 - Not Applicable
Multiple Procedures (51) 9 - Concept does not apply.
Bilateral Surgery (50) 9 - Concept does not apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 9 - Concept does not apply.
Co-Surgeons (62) 9 - Concept does not apply.
Team Surgery (66) 9 - Concept does not apply.
Diagnostic Imaging Family 99 - Concept Does Not Apply
CLIA Waived (QW) No
APC Status Indicator Conditionally packaged laboratory tests
Type of Service (TOS) 5 - Diagnostic Laboratory
Berenson-Eggers TOS (BETOS) T1H - Lab tests - other (non-Medicare fee schedule)
MUE 2
CCS Clinical Classification 233 - Laboratory - Chemistry and Hematology
90 Reference (outside) laboratory: when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number.
GA Waiver of liability statement issued as required by payer policy, individual case
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
GW Service not related to the hospice patient's terminal condition
Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study
26 Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number.
Q4 Service for ordering/referring physician qualifies as a service exemption
Q0 Investigational clinical service provided in a clinical research study that is in an approved clinical research study
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
QJ Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b)
GZ Item or service expected to be denied as not reasonable and necessary
91 Repeat clinical diagnostic laboratory test: in the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of modifier 91. note: this modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. this modifier may not be used when other code(s) describe a series of test results (eg, glucose tolerance tests, evocative/suppression testing). this modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient.
GC This service has been performed in part by a resident under the direction of a teaching physician
95 Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system.
AQ Physician providing a service in an unlisted health professional shortage area (hpsa)
AY Item or service furnished to an esrd patient that is not for the treatment of esrd
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
CR Catastrophe/disaster related
GY Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
PO Excepted service provided at an off-campus, outpatient, provider-based department of a hospital
QP Documentation is on file showing that the laboratory test(s) was ordered individually or ordered as a cpt-recognized panel other than automated profile codes 80002-80019, g0058, g0059, and g0060.
QW Clia waived test
SA Nurse practitioner rendering service in collaboration with a physician
X5 Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician
XE Separate encounter, a service that is distinct because it occurred during a separate encounter
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
Date
Action
Notes
2011-01-01 Changed Short description changed.
1999-01-01 Added First appearance in code book in 1999.
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