2025 CPT code 86255
(Active) Effective Date: N/A Revision Date: N/A Laboratory - Immunology Procedures Pathology and Laboratory Procedures Feed
Fluorescent antibody screen for non-infectious agents.
Modifiers may apply depending on the circumstances of service provision. For example, modifier 99 may be used if multiple tests were performed.Consult the official CPT modifier guidelines for appropriate applications.
Medical necessity for this test is established based on the clinical suspicion of a specific autoimmune disorder or other conditions where the presence or absence of certain antibodies is diagnostically relevant.The physician's documentation should clearly link the clinical presentation to the need for this test.
The clinical responsibility lies with the laboratory analyst who performs the technical aspects of the test, including specimen handling, assay execution, and result interpretation. The ordering physician is responsible for the medical decision to order the test and integrating the results into the patient's overall care.
In simple words: This lab test checks a blood sample for antibodies to substances that aren't infections.The test shows only if the antibodies are present (positive) or absent (negative).
This CPT code encompasses the performance of a qualitative fluorescent immunoassay to screen patient serum for antibodies against non-infectious agents.The procedure involves reacting the specimen with test antigens, incubating, adding a fluorescent agent to detect the antigen-antibody complex, reading the reaction using fluorescence microscopy, and interpreting the results as positive or negative.Examples of target antibodies include smooth muscle antibodies (associated with liver disease) and antineutrophilic cytoplasmic antibodies (ANCA, linked to autoimmune vasculitis).
Example 1: A patient presents with symptoms suggestive of autoimmune hepatitis.The physician orders this test to screen for smooth muscle antibodies as a diagnostic aid., A patient with suspected granulomatosis with polyangiitis (GPA) undergoes testing for antineutrophilic cytoplasmic antibodies (ANCA) to confirm the diagnosis.This test is used as part of the diagnostic workup., A patient with suspected celiac disease is screened for endomysial antibodies. A positive result would support the diagnosis and aid clinical management.
** This code is for a qualitative screen; a separate code may be used for quantitative antibody titers.Always cross-reference with payer-specific policies and local coverage determinations (LCDs) for accurate billing and reimbursement.
- Revenue Code: T1H (LAB TESTS - OTHER)
- RVU: The RVUs for this code will vary based on geographic location and payer. Consult your local fee schedule for precise values.
- Global Days: Not applicable; this is a laboratory test.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier is usually not applicable to this code, as the test is primarily performed in a laboratory setting.
- Fee Schedule: Historical fee schedule data is not readily available within this dataset and can vary greatly based on payer, location, and date. For accurate historical fee schedule details, refer to publicly available resources or specific payer guidelines.
- Specialties:Immunology, Rheumatology, Gastroenterology, Pathology
- Place of Service:Laboratory, Hospital, Physician Office