Summary & Overview
CPT 86015: Anti‑Actin (Smooth Muscle) Antibody (ASMA) Test
CPT code 86015 identifies a laboratory immunoassay that detects anti–actin (smooth muscle) antibodies (ASMA) in serum. ASMA testing is clinically relevant for the evaluation of autoimmune hepatitis (AIH) and other immune-mediated liver disorders; results can influence diagnostic classification and subsequent specialty care. The code represents a discrete laboratory service commonly performed in hospital and reference laboratories and billed by clinical labs.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for ASMA testing, typical sites of service, common billing considerations, and the payer landscape. The publication presents benchmarks for utilization and reimbursement where available, highlights policy updates affecting laboratory test coverage and billing, and summarizes clinical implications for ordering clinicians and laboratory providers.
This summary is intended for a national audience and focuses on code definition, clinical relevance, payer coverage patterns, and operational considerations for laboratories and health systems. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 86015 describes a laboratory test that detects an antibody to actin (smooth muscle) (ASMA) in a specimen such as serum. The assay is typically performed using an immunoassay method, for example an enzyme–linked immunosorbent assay (ELISA), and is used as part of the serologic evaluation for autoimmune hepatitis (AIH), a condition characterized by chronic liver inflammation caused by immune-mediated injury to hepatocytes.
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Service type: Immunoassay laboratory test for autoantibody detection
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Typical site of service: Clinical laboratory or hospital laboratory; specimens are usually collected in an outpatient clinic, hospital, or specialty care setting prior to laboratory analysis
Clinical & Coding Specifications
Clinical Context
A 42-year-old woman presents to her primary care physician with progressive fatigue, mild jaundice, and intermittent right upper quadrant discomfort. Liver function tests reveal elevated aminotransferases and an elevated IgG. The clinician suspects autoimmune hepatitis and orders serologic testing, including an anti–smooth muscle antibody test. A serum specimen is collected in the outpatient phlebotomy area or clinic laboratory and sent to the hospital clinical immunology laboratory. The laboratory performs an immunoassay (commonly ELISA) to detect antibody to actin (smooth muscle) reported as positive/negative with titer or semi-quantitative result. Results are routed to the ordering clinician for interpretation and incorporation into diagnostic evaluation and management of suspected autoimmune hepatitis. Typical site of service: outpatient clinic or ambulatory phlebotomy collection and clinical laboratory testing site.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when a separate professional interpretation by a pathologist or laboratory physician is billed separately from the technical testing component. |
TC | Technical component |