2025 CPT code 86592
(Active) Effective Date: N/A Revision Date: N/A Pathology and Laboratory Procedures - Qualitative or Semiquantitative Immunoassays Immunology Procedures Feed
Qualitative non-treponemal antibody test for syphilis detection using methods like RPR, ART, or VDRL.
Modifiers may apply depending on the circumstances of service (e.g., 99 for multiple tests).Always refer to the most recent payer guidelines for the definitive list of applicable modifiers.
Medical necessity is established when the physician orders the test based on clinical suspicion of syphilis, as part of routine screening, or to monitor treatment response in patients with known syphilis or neurosyphilis.Documentation of symptoms, risk factors, and the rationale for ordering the test must support medical necessity.
The clinical responsibility lies with the laboratory analyst who performs the test and interprets the results. The ordering physician is responsible for clinical decision-making based on the test results.
In simple words: This lab test checks for antibodies related to syphilis in a blood or spinal fluid sample. It uses special tests to see if these antibodies are present. This is often a first step in checking for syphilis; a positive result usually requires further testing to confirm the diagnosis.
This CPT code represents a qualitative non-treponemal antibody test used to detect the presence of syphilis-related antibodies in patient serum or cerebrospinal fluid (CSF) specimens.The test employs antigen tests such as rapid plasma reagin (RPR), automated reagin test (ART), or Venereal Disease Research Laboratory test (VDRL). The procedure involves mixing the antigen reagent with the patient specimen and evaluating the presence of reagin based on flocculation or aggregation of the antibody/antigen complex.While not solely for syphilis diagnosis, it serves as an initial screening test, demonstrating high sensitivity during the middle stages of the infection. The test's results can also inform treatment evaluation as antibody levels decline with successful syphilis treatment. A positive result typically necessitates a confirmatory treponemal antibody test (e.g., CPT code 86780) unless prior syphilis diagnosis exists. CSF testing may be used for neurosyphilis diagnosis.
Example 1: A patient presents with symptoms suggestive of syphilis.The physician orders a qualitative non-treponemal antibody test (86592) as an initial screening test. A positive result leads to further confirmatory testing with a treponemal antibody test., A pregnant woman undergoes routine prenatal testing.As part of the STI screening, a qualitative non-treponemal antibody test (86592) is performed. The result is negative, indicating no evidence of syphilis infection., A patient with a history of neurosyphilis undergoes CSF analysis.The physician orders 86592 to monitor the effectiveness of treatment for neurosyphilis.Serial testing allows monitoring the antibody levels as an indicator of response to therapy.
* Patient demographics and identification.* Physician's order specifying the test.* Specimen collection date and time.* Specimen type (serum or CSF).* Test results.* Interpretation and report.* Clinician's notes related to the clinical indication for the test.
** Always refer to the most current AMA CPT codebook and payer-specific guidelines for definitive coding instructions.This information is for general guidance only and should not be used as the sole basis for coding decisions.
- Revenue Code: T1H (LAB TESTS - OTHER (NON-MEDICARE FEE SCHEDULE))
- RVU: RVUs vary by payer and geographic location.Consult your specific payer's fee schedule for the most up-to-date information.
- Global Days: Not applicable; this is a laboratory test.
- Payment Status: Active
- Modifier TC rule: Not applicable; this is a laboratory test.
- Fee Schedule: Historical fee schedule data varies by payer and geographic location. Contact your payer for historical fee data.
- Specialties:Infectious Disease, Obstetrics/Gynecology, Internal Medicine, Pathology, Microbiology
- Place of Service:Laboratory, Hospital, Physician's Office