2025 CPT code 86256
(Active) Effective Date: N/A Revision Date: N/A Laboratory - Immunology Procedures Pathology and Laboratory Procedures Feed
Qualitative or semiquantitative fluorescent immunoassay to determine antibody titer to a noninfectious agent.
Modifiers may apply depending on the circumstances of service. Refer to the CPT manual and payer guidelines for appropriate modifier usage.
Medical necessity for this test is established when the ordering physician has a clinical indication, such as suspected autoimmune disease, liver disease, or monitoring of a known condition. The test's results help guide diagnosis and treatment.
The clinical responsibility lies with the laboratory analyst who performs the technical aspects of the test. The ordering physician is responsible for medical decision-making based on the results.
In simple words: This lab test measures the amount of antibodies in your blood that target a non-infectious substance.The test uses special fluorescent techniques to determine the antibody level, helping doctors monitor conditions like autoimmune diseases or liver problems.
This CPT code, 86256, encompasses the performance of a qualitative or semiquantitative fluorescent immunoassay to measure the antibody titer against a noninfectious agent in a patient's serum or blood sample.The procedure involves the technical steps of reacting the specimen with test antigens, incubation, addition of a fluorescent agent to detect the antigen-antibody complex, reading the reaction using a fluorescence microscope or viewer, and interpretation of results as a titer representing the antibody amount.The assay is not limited to specific conditions, but clinicians may order it to monitor disease progression or response to treatment in various conditions, such as autoimmune diseases or liver disease.
Example 1: A patient presents with symptoms suggestive of autoimmune hepatitis. The physician orders this test to measure the level of smooth muscle antibodies in the patient's serum., A patient is being monitored for the progression of systemic lupus erythematosus (SLE).This test is used to quantify antinuclear antibodies (ANA) to track disease activity., A patient with suspected celiac disease undergoes testing for anti-tissue transglutaminase antibodies (tTG-IgA) and anti-endomysial antibodies (EMA) as part of the diagnostic workup.This specific code might be used if the laboratory uses a fluorescent immunoassay method for this particular test.
* Physician's order specifying the requested test.* Patient demographics and relevant medical history.* Properly labeled and collected serum or blood sample.* Complete laboratory report including the titer result and interpretation.
** Always cross-reference with payer-specific coding guidelines and medical policies.Specific interpretations and payment policies may differ.
- Revenue Code: T1H (LAB TESTS - OTHER (NON-MEDICARE FEE SCHEDULE))
- RVU: Data not available in source.RVUs vary by payer and location. Consult your local fee schedule.
- Global Days: Not applicable. This is a laboratory test, not a surgical procedure.
- Payment Status: Active
- Modifier TC rule: Not applicable; this is a lab test.The technical component is inherent in the code.
- Fee Schedule: Historical fee schedule data is not provided in the source; consult your local fee schedule database for historical trends.
- Specialties:Immunology, Rheumatology, Gastroenterology, Hepatology
- Place of Service:Office, Hospital (Inpatient and Outpatient), Clinical Laboratory