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36.4.22.1 Blood Counts
The Texas Medicaid Program considers a baseline CBC appropriate for the E/M of existing and suspected disease processes. CBCs should be individualized and based on client history, clinical indications or proposed therapy and will not be reimbursed for screening purposes.
A CBC is a comprehensive service that includes components. A CBC is billed with one of the following procedure codes: 5-85025, 5-85027, and 5-85032.
The components of a CBC are listed in the following table. Any of these procedure codes billed for the same date of service as a CBC procedure code will deny as part of another service:
The following procedure codes will be denied as part of another service when billed with procedure code 5-85025 for the same date of service by the same provider:
Procedure code 5-85004 is denied as part of another service when billed with procedure code 5-85007, 5-85009, 5-85025, or 5-85027 for the same date of service by the same provider.
Procedure code 5-85008 is denied as part of another service when billed with the following procedure codes for the same date of service by the same provider:
Procedure code 5-85013, 5-85014, or 5-85018 is denied as part of another service when billed with procedure code 5-85025 or 5-85027 for the same date of service by the same provider.
Procedure code 5-85032 is denied as part of another service when billed with procedure code 5-85025, 5-85027, 5-85041, 5-85048, or 5-85049.
Procedure code 5-85044 is denied as part of another service when billed with procedure code 5-85045 or 5-85046.
Procedure code 5-85045 is denied as part of another service when billed with procedure code 5-85046.
Procedure codes 5-85041, 5-85048, and 5-85049 will be denied as part of another service when billed with procedure code 5-85025 or 5-85027.
Procedure code 5-85049 may be reimbursed separately in addition to procedure codes 5-85014, 5-85018, and 5-85032.
The following reticulocyte procedure codes may be reimbursed in addition to a CBC: 5-85044, 5-85045, and 5-85046.
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