2025 CPT code 86200
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Laboratory - Immunology Procedures Pathology and Laboratory Procedures Feed
Qualitative or semiquantitative immunoassay to detect cyclic citrullinated peptide (CCP) antibodies, typically in serum.
Modifiers 90 (reference laboratory), 91 (repeat test), and others may be applicable depending on the specific circumstances of service.
Medical necessity for anti-CCP testing (86200) is established when it is part of the diagnostic workup for suspected rheumatoid arthritis.The test may be used to support or refute a clinical diagnosis.For monitoring, payers may require additional justification showing the clinical need to track disease progression or treatment efficacy.
The clinical responsibility lies with the laboratory analyst who performs the technical aspects of the test, including specimen handling, assay performance, and result interpretation. The ordering physician is responsible for medical decision-making based on the results.
In simple words: This lab test checks for CCP antibodies in your blood.CCP antibodies are often found in people with rheumatoid arthritis (RA), a type of arthritis.The test helps doctors tell the difference between RA and other kinds of arthritis.
This CPT code represents a laboratory test that qualitatively or semiquantitatively measures the presence of cyclic citrullinated peptide (CCP) antibodies in a patient's serum sample.The test utilizes an immunoassay technique, such as enzyme-linked immunosorbent assay (ELISA), to detect these antibodies.Results are typically reported as negative, weak positive, positive, or strongly positive. The presence of CCP antibodies is highly specific for Rheumatoid Arthritis (RA) and can aid in differentiating RA from other forms of arthritis.The test involves adding the serum sample to wells containing synthetic CCP, incubating, adding an enzyme, and reading the reaction using a spectrophotometer.
Example 1: A 50-year-old female presents with joint pain and swelling.Her physician orders an anti-CCP antibody test (86200) to aid in the diagnosis of rheumatoid arthritis., A 45-year-old male with a history of positive rheumatoid factor (RF) but inconclusive clinical presentation undergoes anti-CCP antibody testing (86200) for improved diagnostic accuracy., A 60-year-old female with RA is being monitored for disease activity and treatment response. Serial anti-CCP antibody tests (86200) are ordered to assess the effectiveness of her medication.
* Patient demographics and relevant clinical history.* Physician's order specifying the test.* Results of the anti-CCP antibody test.* Complete documentation supporting medical necessity, including clinical presentation, physical examination findings, and differential diagnosis.
** Payers may have specific requirements or policies regarding the medical necessity of this test and may require preauthorization or additional documentation.
- Revenue Code: T1H (LAB TESTS - OTHER (NON-MEDICARE FEE SCHEDULE))
- RVU: Unknown.RVUs vary depending on payer and location.
- Global Days: Not applicable; this is a laboratory test.
- Payment Status: Active
- Modifier TC rule: Not applicable for this laboratory test.
- Fee Schedule: Historical fee schedule data is not provided but can be obtained through various sources such as CMS, private payers, or third-party billing software.
- Specialties:Rheumatology, Immunology, Pathology
- Place of Service:Office, Hospital, Clinical Laboratory