2025 CPT code 83516
(Active) Effective Date: N/A Revision Date: N/A Laboratory - Chemistry Procedures Pathology and Laboratory Procedures Feed
Immunoassay for analyte (other than infectious agent antibody or antigen); qualitative or semiquantitative, multiple-step method.
Modifiers may be applicable in certain situations, such as modifier 59 (distinct procedural service) if performed on a separate analyte from other tests, or modifier QW (CLIA waived test) if applicable.
Medical necessity is established by the physician's clinical judgment based on the patient's symptoms, medical history, and diagnostic findings.The test must be deemed appropriate for the specific clinical indication and should contribute to the diagnosis, treatment, or management of the patient's condition.
The clinical laboratory personnel are responsible for performing the test, which involves collecting the specimen, processing it through the various steps of the immunoassay, analyzing the results, and reporting the findings to the ordering physician.
In simple words: This lab test uses a special method (immunoassay) to check for a specific substance in your body. The result will either show if the substance is present or not, or give a number showing how much is present. This involves several steps and is used for substances that are not infection-related.
This CPT code encompasses immunoassay procedures for detecting and measuring analytes (excluding infectious agent antibodies or antigens) using a multi-step method.The results are either qualitative (positive/negative) or semiquantitative (providing a numerical range indicating normal/abnormal levels).The test involves multiple steps including specimen preparation, incubation, centrifugation, instrumental analysis, and result interpretation.Specific examples of immunoassay methods include enzyme immunoassay (EIA) and fluoroimmunoassay (FIA). This code is restricted to one unit of service per analyte unless multiple distinct analytes are tested.
Example 1: A patient presents with symptoms suggestive of an autoimmune disorder.The physician orders a test using code 83516 to measure the level of a specific autoantibody in the patient's serum.This helps determine the diagnosis and guide treatment., A patient is being monitored for drug levels as part of therapeutic drug monitoring.Code 83516 is used to measure the concentration of a specific medication in the patient's blood, ensuring the dosage is appropriate and safe., During a fertility evaluation, an anti-Müllerian hormone (AMH) level is measured using code 83516 to assess ovarian reserve and predict a woman's response to fertility treatments.
* Physician's order specifying the analyte to be tested.* Complete patient demographics and relevant medical history.* Properly collected and labeled specimen (blood, urine, etc.).* Detailed test results with units and reference ranges.
** Payers may have specific coverage policies regarding this code, so it's crucial to verify reimbursement guidelines with the individual payer before submitting the claim.
- Revenue Code: T1H (LAB TESTS - OTHER (NON-MEDICARE FEE SCHEDULE))
- RVU: RVUs vary depending on payer, location, and other factors. Consult your specific payer's fee schedule.
- Global Days: Not applicable.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Historical fee schedules are unavailable, but can be obtained from the AMA or individual payers.
- Specialties:Endocrinology, Immunology, Oncology, and other specialties where analyte testing is necessary.
- Place of Service:Clinical Laboratory