A diagnostic phlebotomy for the collection or withdrawal of blood is an eligible service and should be reported under procedure code 36415, or S9529.

A phlebotomy by incision for the removal of a thrombus is an eligible service and should be reported under procedure code 34401-34490.

A phlebotomy performed for therapeutic purposes is an eligible procedure and should be reported under code 99195 (phlebotomy, therapeutic). The conditions/diagnoses under which a therapeutic phlebotomy can be paid are as follows:

1. Polycythemia vera (238.4)
2. Polycythemia secondary (289.0) to:
   
   • Cyanotic congenital heart disease (746.9) or Cor pulmonale (415.0, 416.9)
   • A-V fistulae
3. Hemochromatosis (275.0)
4. Porphyria cutanea tarda (277.1)

If a therapeutic phlebotomy is reported for a condition/diagnosis other than those listed, it should be denied as not medically necessary and, therefore, not covered. A participating, preferred, or network provider cannot bill the member for the denied service.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Payment may be made for collection and handling of blood (i.e., diagnostic phlebotomy, see Medical Policy Bulletin L-2).