Laboratory Question for the Week of June 10, 2024

Question:

When applying an “antibody cocktail” which contains two or more separately interpretable antibodies, providers should refer to the NCCI policy narrative to determine billable units of service. According to the NCCI, how is the unit of service for immunohistochemistry defined and what are the guidelines for reporting multiplex antibody immunohistochemical staining procedures and antibody cocktails?

Answer:

When applying an “antibody cocktail” that contain two or more separately interpretable antibodies providers should read the statement applicable to determine billable units of service as published in the NCCI policy narrative. The NCCI defines the unit of service for immunohistochemistry as “each single or multiplex antibody stain procedure per specimen. A multiplex antibody immunohistochemical staining procedure is one that uses multiple antibodies to obtain multiple separately reportable medically reasonable and necessary results. An antibody stain containing multiple antibodies that yields a single reportable result is not a multiplex stain and shall be reported with a single antibody staining procedure CPT® code. An immunohistochemistry stain procedure with multiple antibodies that are not separately interpretable (e.g., antibody cocktail) shall only be reported as one (1) unit of service per specimen.”

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