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.
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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 | Use when billing only the laboratory processing, equipment and technician portion of the test. |
59 | Distinct procedural service | Use when this test is billed on the same day as another laboratory or diagnostic service and meets criteria for a distinct service. |
90 | Reference (outside) laboratory | Use when the specimen is sent to an outside/reference laboratory and the billing provider is reporting testing performed elsewhere. |
91 | Repeat clinical diagnostic lab test | Use when the same test is repeated on the same day for monitoring or verification purposes when allowable. |
52 | Reduced services | Use when an abbreviated or partial version of the test is performed and the payer allows reduced payment. |
53 | Discontinued procedure | Use when specimen collection or testing was started but discontinued for documented clinical reasons. |
22 | Increased procedural services | Use when obtaining and processing the specimen required substantially greater work or complexity than usual and documentation supports increased work. |
90 | Reference (outside) laboratory | Use when the performing laboratory is external and the billing requires identification of outside testing. |
QX | CLIA waived or moderate/complex split billing modifier (when applicable under CLIA regulations) | Use per payer policy when distinguishing responsibilities between performing lab and billing entity under applicable regulations. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207Q00000X | Pathology | Laboratory directors and clinical pathologists who interpret serologic tests. |
| 207L00000X | Clinical Laboratory | Medical technologists and laboratory medicine specialists who perform immunoassays. |
| 207K00000X | Gastroenterology | Gastroenterologists who evaluate suspected autoimmune hepatitis and order ASMA testing. |
| 207RH0000X | Internal Medicine | Internists and primary care physicians who initiate testing for liver disease. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
K75.4 | Autoimmune hepatitis | Primary indication for ordering anti–smooth muscle antibody (86015) to support diagnosis. |
K76.9 | Liver disease, unspecified | Used when liver disease is present but specific etiology pending serologic evaluation including 86015. |
R17 | Unspecified jaundice | Symptom prompting liver serologies and autoimmune markers including ASMA testing. |
R74.0 | Nonspecific elevation of levels of transaminase and lactic dehydrogenase | Laboratory abnormality that triggers testing for autoimmune and other causes of hepatitis, including 86015. |
K85.9 | Acute pancreatitis, unspecified | Included when broader hepatobiliary workup is performed; liver autoantibody testing may be part of differential evaluation. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
36415 | Collection of venous blood by venipuncture | Specimen collection for serum required prior to performing the 86015 serologic assay. |
80076 | Hepatic function panel | Common initial blood panel ordered alongside 86015 to evaluate liver enzymes and synthetic function in suspected autoimmune hepatitis. |
86850 | Infectious agent antibody detection by immunoassay technique (e.g., ELISA), qualitative or semiquantitative, multiple-step method; 1-3 tests | Other serologic immunoassays often ordered concurrently; clarifies laboratory workflow when multiple immunoassays are run. |
86308 | Immunoassay for analyte other than infectious agent antibody, quantitative or semi-quantitative, each specimen | Laboratory immunoassay code that may be used for related serologic testing methodologies in the lab workflow. |
80061 | Lipid panel | Ordered in broader evaluation of chronic liver disease and metabolic risk factors; often part of concurrent laboratory workup. |