2025 CPT code 86430
Effective Date: N/A Pathology and Laboratory Procedures > Immunology Procedures Feed
Rheumatoid factor; qualitative
Modifiers may be applicable. Modifier 90 indicates testing performed by an outside laboratory, while modifier 91 signifies a repeat test.
Medical necessity for this test is established when a patient presents with clinical signs and symptoms suggestive of rheumatoid arthritis or other autoimmune disorders where RF presence is a diagnostic factor. The test results contribute to the development of a treatment plan.
The lab analyst performs the technical aspects of the test, including mixing the patient's serum with coated latex beads and interpreting the agglutination reaction. They report the findings as positive or negative for RF.
In simple words: This test checks for rheumatoid factor (RF) in your blood. RF is a type of antibody often present in people with rheumatoid arthritis. The test helps doctors determine if you have this condition.
This qualitative test detects the presence of rheumatoid factor (RF) in a patient's blood sample. RF comprises antibodies targeting the Fc portion of IgG, commonly found in individuals with rheumatoid arthritis. The testing process involves mixing the serum with latex beads coated with human IgG. If RF is present, agglutination (clumping) occurs, indicating a positive result. This test assists in the diagnosis and prognosis of rheumatoid arthritis, differentiating it from other forms of arthritis.
Example 1: A patient presents with joint pain, swelling, and stiffness. The physician orders an RF test (86430) to aid in diagnosing or ruling out rheumatoid arthritis., A patient with existing rheumatoid arthritis experiences an increase in symptoms. An RF test is performed to monitor disease activity and assess treatment response., A patient displays symptoms suggestive of an autoimmune disorder other than rheumatoid arthritis (e.g., Sjögren's syndrome, lupus). An RF test, along with other tests, helps in the differential diagnosis process.
Documentation should include the reason for the test, relevant patient symptoms (e.g., joint pain, stiffness), and any associated medical conditions. The report should indicate whether the test was positive or negative for RF.
- Revenue Code: T1H - LAB TESTS - OTHER (NON-MEDICARE FEE SCHEDULE)
- Specialties:Rheumatology, Immunology, Internal Medicine, Family Medicine
- Place of Service:Office, Independent Laboratory, Hospital Outpatient