2025 CPT code 86481
(Active) Effective Date: N/A Qualitative or Semiquantitative Immunoassays - Immunology Pathology and Laboratory Feed
This code represents a tuberculosis test that measures cell-mediated immunity by counting the number of T-cells producing interferon-gamma in response to specific TB antigens.
Modifiers may apply in specific circumstances, such as if the test is performed on multiple specimens or if there are unusual technical or interpretive challenges. Refer to payer-specific guidelines for appropriate modifier usage.
Medical necessity for this test must be established based on CDC guidelines, considering factors like TB exposure risk, symptoms, and prior test results. The test is medically necessary when used for the diagnosis of latent or active TB infection, particularly in situations where the tuberculin skin test is unreliable (e.g., previous BCG vaccination).Refer to payer-specific guidelines to justify reimbursement of T-SPOT.TB specifically.
Laboratory professionals are responsible for performing the test, including isolating peripheral blood mononuclear cells (PBMCs), incubating and washing test wells, adding substrate solution, and counting the spots formed using magnification.The ordering clinician is responsible for interpreting the results in conjunction with other clinical findings and risk assessment to determine the appropriate course of action.
In simple words: This blood test helps determine if you've been infected with the bacteria that causes tuberculosis (TB). It checks your immune system's response to TB by counting specific cells that react to the TB bacteria.
This test, often referred to as an Interferon Gamma Release Assay (IGRA) like the T-SPOT.TB test, is a blood test used to determine if someone has been infected with Mycobacterium tuberculosis.It involves stimulating a patient's blood cells with specific TB antigens and then counting the number of T cells that produce interferon-gamma, a cytokine indicative of TB infection. This enumeration process provides a more precise measurement of the immune response compared to simply measuring the total amount of interferon-gamma produced. The test methodology utilizes the enzyme-linked immunoSpot (ELISPOT) technique.
Example 1: A patient with a history of possible TB exposure but a negative skin test undergoes an IGRA test using 86481 for a more definitive diagnosis., A healthcare worker requires routine TB screening and opts for the 86481 blood test instead of a skin test due to previous BCG vaccination., A patient with symptoms suggestive of TB undergoes testing with 86481 to aid in confirming the diagnosis and guiding treatment decisions.
Documentation should include the reason for the test, patient's clinical history relevant to TB risk factors, any previous TB testing results, and interpretation of the test results in the context of other diagnostic information.
** Ensure accurate coding by verifying the exact test methodology used by the laboratory. Miscoding can occur if 86481 is used for tests that do not involve cell enumeration.
- Revenue Code: T1H (LAB TESTS - OTHER (NON-MEDICARE FEE SCHEDULE))
- Payment Status: Active
- Specialties:Infectious Disease, Pulmonology, Occupational Medicine
- Place of Service:Office, Independent Clinic, Hospital Outpatient, Public Health Clinic