CPT 3455F TB Screening Reimbursement & Policy

CPT code 3455F identifies screening for latent tuberculosis infection in patients with rheumatoid arthritis before starting disease-modifying antirheumatic drug (DMARD) therapy. This preventive screening is clinically important because immunosuppressive DMARDs increase the risk of reactivation of latent TB, and documenting pre-therapy screening supports safe treatment initiation and payer coverage decisions at the national level. Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context on why LTBI screening matters for RA patients on DMARDs, an explanation of typical service settings and workflows, and a summary of payer considerations and documentation expectations. The publication also outlines common benchmarks and policy updates related to pre-immunosuppression infectious disease screening, and highlights areas where documentation using CPT code 3455F intersects with coverage and prior authorization processes. Data not available in the input for modifiers, associated taxonomies, specific ICD-10 diagnoses, related codes, and detailed payer-by-payer reimbursement rates are noted where applicable.

Billing Code Overview

CPT code 3455F documents that a provider screened a patient with rheumatoid arthritis for latent tuberculosis infection (LTBI) prior to initiating disease-modifying antirheumatic drug (DMARD) therapy. The description indicates that patients receiving DMARDs are at increased risk for TB reactivation, and the code captures the provider’s action of screening to identify latent infection before starting immunosuppressive treatment.

Service type: Pre-therapy infectious disease screening

Typical site of service: Outpatient clinic or rheumatology office, where RA management and pre-treatment evaluations commonly occur.

Data not available in the input.

Clinical Context

A 54-year-old female with established rheumatoid arthritis is scheduled to begin a biologic disease‑modifying antirheumatic drug (DMARD). Prior to initiating therapy, the rheumatology clinic performs tuberculosis screening to identify latent tuberculosis infection (LTBI). The workflow includes a focused history for TB exposure and prior treatment, administration and reading of a tuberculin skin test (TST) or ordering an interferon‑gamma release assay (IGRA) blood test, review of prior chest radiograph results or ordering a chest X‑ray if indicated, and documentation of results and clinical decision‑making in the medical record. Results are communicated to the patient and documented to support the safety assessment prior to starting DMARD therapy.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure	Use when an E/M visit for RA assessment and TB screening is distinct from any procedure performed the same day
`59`	Distinct procedural service	Use to indicate a distinct service when TB testing is performed the same day as another procedure

Taxonomy Code	Specialty	Notes
207R00000X	Rheumatology	Rheumatologists initiate DMARDs and order TB screening prior to therapy
207P00000X	Allergy & Immunology	May evaluate immune status and perform TB screening prior to immunomodulatory therapy
207L00000X	Infectious Disease	Consulted for interpretation of LTBI testing and management recommendations
207Q00000X	Internal Medicine	Primary care physicians often coordinate pre‑DMARD screening and testing
363A00000X	Physician Assistant	PAs commonly perform testing, documentation, and result communication in specialty clinics

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M05.9`	Rheumatoid arthritis with rheumatoid factor, unspecified	Primary diagnosis indicating need for DMARD therapy and pre‑treatment TB screening
`M06.9`	Rheumatoid arthritis, unspecified	Common RA diagnosis prompting evaluation before initiating immunosuppressive therapy
`R76.11`	Reactivity to tuberculin skin test (positive)	Positive TST result requiring further evaluation for latent vs active TB prior to DMARDs
`Z11.1`	Encounter for screening for respiratory tuberculosis	Documented reason for TB screening in asymptomatic patients prior to immunosuppression
`Z79.899`	Other long term (current) drug therapy	May be used when documenting ongoing immunosuppressive drug therapy that affects TB risk

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`86480`	QuantiFERON-TB Gold (IGRA) — detection of Mycobacterium tuberculosis complex specific interferon gamma release	Commonly ordered blood test to screen for latent TB prior to initiating DMARD therapy
`86580`	Tuberculin skin test (Mantoux) administration and interpretation	Frequently used point-of-care screening method for LTBI; includes placement and reading
`71045`	Chest radiograph, single view, frontal	Ordered when TB screening is positive or history suggests prior TB to evaluate for active pulmonary disease
`99000`	Handling and/or conveyance of specimen for transfer to another facility	Used when specimens for IGRA are sent to an external laboratory
`36415`	Collection of venous blood by venipuncture	Performed when ordering IGRA testing as part of the LTBI screen

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Summary & Overview

CPT 3455F: Rheumatoid Arthritis TB Screening Prior to DMARD Therapy