2025 CPT code 86386

Qualitative immunoassay for Nuclear Matrix Protein 22 (NMP22) in urine.

Follow current CPT coding guidelines for immunology procedures and the specific instructions for code 86386.Consider using modifier QW if the test is performed using a CLIA-waived method and submitted to a payer (such as Medicare) that accepts this modifier for this test. Pay close attention to payer-specific guidelines.

Modifiers may be applicable depending on the specific circumstances of service. Consult the CPT manual and payer guidelines.

Medical necessity for this test is established when there is clinical suspicion of bladder cancer, based on symptoms (e.g., hematuria, frequency, urgency), risk factors (e.g., smoking, exposure to certain chemicals), or history of bladder cancer.It is also medically necessary for monitoring for recurrence in patients with a history of bladder cancer following treatment.Payers may have specific criteria for coverage; documentation must meet payer requirements.

The clinical responsibility lies with the laboratory analyst who performs the technical aspects of the test, including sample preparation, reagent mixing, and result interpretation.The ordering physician is responsible for interpreting the results in the context of the patient's clinical presentation and ordering additional tests as needed.

IMPORTANT For Ouchterlony diffusion, use code 86331. For platelet antibodies, see codes 86022 and 86023.

In simple words: This lab test checks a urine sample for a protein called NMP22, which is often higher in people with bladder cancer.The result will show whether the protein level is elevated or not. This test helps doctors diagnose or monitor bladder cancer but isn't a replacement for other standard tests.

This CPT code, 86386, reports a qualitative or semiquantitative immunoassay to detect the presence of Nuclear Matrix Protein 22 (NMP22) in a urine sample.The test is used as an aid in diagnosing bladder cancer or monitoring its progression, often employing methods like enzyme immunoassay.Results are reported as positive or negative for elevated NMP22 levels. This is an adjunct test and should not replace standard diagnostic procedures like cystoscopy.

Example 1: A patient presents with hematuria (blood in urine) and suspicion of bladder cancer. The physician orders the NMP22 test to aid in diagnosis before proceeding to cystoscopy., A patient with a history of bladder cancer has undergone surgery. The NMP22 test is used post-surgery to monitor for recurrence., A patient with symptoms suggestive of bladder cancer undergoes NMP22 testing along with other diagnostic procedures (e.g., cystoscopy and urine cytology) to confirm diagnosis.

Patient demographics, test requisition with clinical indication, date and time of urine collection, method of urine collection (e.g., voided, catheterized), results of the NMP22 assay (positive or negative), and any relevant clinical notes from the ordering physician.For CLIA-waived tests, documentation supporting CLIA waiver compliance.

** The sensitivity and specificity of this test vary across different studies. Results should be interpreted in conjunction with other clinical findings.Ensure appropriate documentation of the testing method (e.g., Alere NMP22 BladderChek) to clarify to the payer the specific method used.

  • Revenue Code: T1H (LAB TESTS - OTHER (NON-MEDICARE FEE SCHEDULE))
  • RVU: Information not available.RVUs vary based on geographic location and payer.
  • Global Days : Not applicable.This is a laboratory test, not a surgical procedure.
  • Payment Status: Active
  • Modifier TC rule: Not applicable; this is a laboratory test.
  • Fee Schedule : Fee schedules vary by payer, location, and year.Consult payer-specific fee schedules for historical data.
  • Specialties:Urology, Oncology, Pathology
  • Place of Service:Laboratory, Hospital (Inpatient/Outpatient), Physician's Office
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