CPT® Code 86826

Official Description

Human leukocyte antigen (HLA) crossmatch, non-cytotoxic (eg, using flow cytometry); each additional serum sample or sample dilution (List separately in addition to primary procedure)

Common Language Description

Human leukocyte antigens (HLA) are specific protein molecules located on the surface of most body cells, playing a crucial role in the immune system's ability to recognize foreign cells. These antigens are vital for determining compatibility in organ and tissue transplant procedures. In the context of transplantation, the presence of certain HLA markers can significantly influence the success of the procedure. While there are numerous HLA molecules, only a select few—typically six—are assessed during transplant crossmatch procedures to ensure compatibility between the donor and recipient. The process begins with typing the HLAs, which involves identifying the specific HLA markers present in both the recipient and the donor. This typing is conducted as a separate procedure prior to the crossmatch. Ideally, the donor and recipient will share identical HLA markers; however, if discrepancies exist, transplantation may still be feasible if the recipient has not developed antibodies against the donor's HLA markers. The presence of such antibodies can lead to an immune response that attacks the transplanted cells, tissue, or organ. To perform the crossmatch, blood samples are collected from both the donor and recipient. The donor's cells are then combined with the recipient's serum, and the mixture is analyzed for reactions using a non-cytotoxic method, such as flow cytometry. A negative reaction indicates compatibility, suggesting that the recipient does not possess antibodies against the donor's HLA, thereby allowing the transplant to proceed. Conversely, a positive reaction signifies the presence of antibodies, indicating that transplantation is not advisable. For billing purposes, CPT® Code 86825 is used for the first serum sample or dilution, while CPT® Code 86826 is designated for each additional serum sample or sample dilution.

1. Indications

The HLA crossmatch procedure is indicated in the following scenarios:

Transplant Compatibility Testing This procedure is performed to assess the compatibility between a donor and a recipient prior to organ or tissue transplantation.
Antibody Detection It is utilized to determine if the recipient has developed antibodies against the donor's HLA markers, which could lead to transplant rejection.

2. Procedure

The HLA crossmatch procedure involves several critical steps to ensure accurate compatibility testing:

Step 1: Blood Sample Collection Blood samples are obtained from both the donor and the recipient. This is a crucial first step, as the samples will be used to identify the presence of HLA markers and any potential antibodies.
Step 2: HLA Typing Prior to the crossmatch, HLA typing is performed to determine the specific HLA markers present in both the donor and recipient. This step is essential for understanding the compatibility between the two parties.
Step 3: Mixing Samples The donor's cells are mixed with the recipient's serum in a controlled laboratory environment. This mixture is then observed for any reactions that may indicate the presence of antibodies.
Step 4: Reaction Analysis The mixture is analyzed using a non-cytotoxic methodology, such as flow cytometry. This analysis helps to identify whether there is a positive or negative reaction between the donor's HLA and the recipient's serum.
Step 5: Interpretation of Results A negative reaction indicates that the recipient does not have antibodies against the donor's HLA, suggesting that transplantation can proceed. Conversely, a positive reaction indicates the presence of antibodies, which would contraindicate the transplant.

3. Post-Procedure

After the HLA crossmatch procedure, the results are carefully reviewed and interpreted by the healthcare team. If the crossmatch is negative, the transplant can be scheduled, and the recipient may proceed with pre-transplant preparations. If the crossmatch is positive, further evaluation and alternative strategies may be considered to address the incompatibility, which could include desensitization protocols or seeking alternative donors. Continuous monitoring of the recipient's antibody levels may also be necessary to ensure the best possible outcomes for future transplant attempts.

Short Descr	HLA X-MATCH NONCYTOTOXC ADDL
Medium Descr	HLA CROSSMATCH NONCYTOTOXIC ADDL SERUM/DILUTION
Long Descr	Human leukocyte antigen (HLA) crossmatch, non-cytotoxic (eg, using flow cytometry); each additional serum sample or sample dilution (List separately in addition to primary procedure)
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	206 - Microscopic examination (bacterial smear, culture, toxicology)

This is an add-on code that must be used in conjunction with one of these primary codes.

86825

MPFS Status: Statutory exclusion (from MPFS, may be paid under other methodologies) APC Q4 Human leukocyte antigen (HLA) crossmatch, non-cytotoxic (eg, using flow cytometry); first serum sample or dilution

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.