Clinical Context
A 28-year-old sexually active patient presents to an outpatient community sexual health clinic with concerns of recent high-risk exposure and new genital lesions. The clinician obtains a sexual history, performs a focused physical exam, and orders laboratory testing for sexually transmitted infections. The clinic collects a serum specimen and submits it to the on-site or reference laboratory for the BioPlex™ 2200 Syphilis Total & RPR Assay. The test performs a single immunoassay panel that simultaneously evaluates total treponemal antibodies and non-treponemal rapid plasma reagin (RPR) reactivity to aid in the diagnosis of syphilis or to monitor treatment response. Typical workflow steps: sample collection, specimen labeling, laboratory accessioning, automated running of the BioPlex™ 2200 instrument, result verification by laboratory personnel, and electronic reporting of combined treponemal and non-treponemal results to the ordering clinician for interpretation and treatment planning. Typical sites of service include outpatient clinics, public health/STI clinics, physician offices, and clinical laboratories. The service type is a laboratory diagnostic assay (Proprietary Laboratory Analyses).
Coding Specifications
| Modifier | Description | When to Use |
|---|
00 | Placeholder for standard reporting | Use when no specific modifier applies and the payer requires explicit reporting of baseline modifier; generally not used clinically. |
| 11 | Professional component | Use when only the professional component (interpretation) of a combined service is reported by the performing physician or lab professional. |
| 26 | Professional component | Use when reporting only the professional component of a test if allowed by payer (interpretation/consult). |
| 90 | Reference (outside) laboratory | Use when the test was performed by an outside/reference laboratory and the billing provider is reporting reference lab services. |
| TC | Technical component | Use when billing only the technical component of the assay (laboratory instrument, supplies, technician time) separate from professional interpretation. |
| 52 | Reduced services | Use when the test is performed but at a reduced scope or yields limited data due to specimen quality or partial processing. |
| 53 | Discontinued procedure | Use when testing was started but discontinued for documented medical reasons before completion. |
| 59 | Distinct procedural service | Not in provided list; omitted to comply with input. |
| 90 | Reference (duplicated) | Duplicate entry omitted; single 90 retained above. |
| 82 | Assistant surgeon (when qualified resident unavailable) | Rarely used for laboratory tests; not typically applicable but included among available modifiers when surgical assistance is billed in same encounter. |
| 22 | Increased procedural services | Use when test processing required substantially greater effort or complexity beyond the typical assay (documented and supported). |
| 23 | Unusual anesthesia | Not applicable to lab testing; avoid use for this procedure. |
| 52 | Reduced services (duplicated) | Duplicate omitted; single 52 retained above. |
| 90 | Reference laboratory (final) | See single 90 entry above. |
| Taxonomy Code | Specialty | Notes |
|---|
| 207Q00000X | Infectious Disease | Specialists who interpret complex serologic panels and manage syphilis diagnosis and treatment. |
| 207L00000X | Pathology | Laboratory directors and pathologists overseeing test validation, verification, and reporting. |
| 208000000X | Family Medicine | Primary care clinicians who order syphilis testing in outpatient settings. |
| 208D00000X | Obstetrics & Gynecology | OB/GYN clinicians ordering syphilis screening for prenatal care or symptomatic patients. |
| 208000000X | Internal Medicine | Internists managing STI screening and follow-up, including treatment monitoring. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|
A53.9 | Syphilis, unspecified | Primary code for suspected or confirmed syphilis when stage is not specified; directly indicates clinical need for treponemal and non-treponemal testing. |
| A52.9 | Late syphilis, unspecified | Used when monitoring or diagnosing later stages of syphilis; serologic testing guides staging and management. |
| A51.9 | Early syphilis, unspecified | Applied for early-stage syphilis evaluation; serologic panel helps confirm diagnosis. |
| Z11.3 | Encounter for screening for infections with a predominantly sexual mode of transmission | Used for routine STI screening including syphilis in asymptomatic patients; justifies ordering the assay. |
| O98.8 | Other specified infectious and parasitic diseases complicating pregnancy, childbirth and the puerperium | Used in prenatal screening contexts where syphilis testing is required to protect maternal and fetal health. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
80061 | Lipid panel; includes total cholesterol, HDL, LDL, triglycerides | Data not available in the input. |
| 86631 | Antibody; Treponema pallidum (syphilis) | Used as a standalone treponemal antibody test in workflows where separate treponemal testing is billed instead of the proprietary PLA. |
| 86592 | Antigen or antibody detection by immunoassay, each procedure; qualitative or semiquantitative | Represents general immunoassay methodology; may be billed for similar non-proprietary immunoassays when PLA code is not used. |
| 87481 | Infectious agent antigen detection by nucleic acid (e.g., Chlamydia trachomatis), amplified probe technique | Example of other STI molecular tests commonly ordered concurrently in the same encounter (screening panel). |
| 36415 | Collection of venous blood by venipuncture | Performed prior to running the BioPlex™ assay to obtain the serum specimen. |
| 99000 | Handling and/or conveyance of specimen to a laboratory | Represents logistical specimen handling often associated with laboratory testing in some payer systems. |