Summary & Overview
CPT 86036: Antineutrophil Cytoplasmic Antibody (ANCA) Test
CPT code 86036 represents a laboratory immunology assay for antineutrophil cytoplasmic antibodies (ANCA), used to detect pANCA and cANCA patterns in serum. The test is clinically important because ANCA results contribute to diagnosis and management of autoimmune vasculitides and related systemic autoimmune disorders; accurate coding supports appropriate laboratory payment and clinical documentation nationwide. Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of the clinical context for CPT code 86036, the typical sites of service and service type, and the major payer coverage landscape. The publication summarizes common billing and coding considerations, relevant modifiers provided in the input, and how this assay fits into diagnostic workflows. It also provides benchmarks and policy updates where available; if specific payer policy details are not present, the text notes that Data not available in the input. The goal is to give laboratory managers, billing professionals, and clinical leaders a national-level briefing on coding, coverage patterns, and operational implications for ordering and reimbursing ANCA testing under CPT code 86036.
Billing Code Overview
CPT code 86036 describes a laboratory test that detects antibodies to neutrophils (antineutrophil cytoplasmic antibody, ANCA) in a patient specimen such as serum, typically performed using methods like fluorescence immunoassay. The test identifies ANCA patterns such as pANCA and cANCA, which help clinicians distinguish among autoimmune disorders, including forms of vasculitis and other systemic autoimmune diseases.
Service Type: Laboratory diagnostic immunology test
Typical Site of Service: Clinical laboratory or hospital laboratory; specimens collected in outpatient clinics or inpatient settings
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient with new-onset systemic symptoms of fatigue, low-grade fever, and unexplained weight loss presents to rheumatology after routine labs show an elevated erythrocyte sedimentation rate and persistent hematuria on urinalysis. The clinician suspects a small-vessel vasculitis such as granulomatosis with polyangiitis or microscopic polyangiitis and orders serologic testing including 86036 (antineutrophil cytoplasmic antibody, ANCA) to detect pANCA or cANCA patterns. A phlebotomy is performed in an outpatient clinic or hospital laboratory; serum is sent to the clinical immunology lab where a fluorescence immunoassay is used to detect ANCA titers and patterns. Results are interpreted by a laboratory director and reported to the ordering provider to guide further diagnostic workup (e.g., imaging, tissue biopsy) and treatment planning (e.g., immunosuppressive therapy). Typical sites of service include outpatient physician offices, hospital outpatient laboratories, and independent reference laboratories. Common patient scenarios include evaluation of suspected systemic vasculitis, workup of unexplained renal involvement with hematuria/proteinuria, assessment of autoimmune disease flares, or differentiation among autoimmune syndromes presenting with pulmonary and renal manifestations.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting the physician or pathologist interpretation separate from the technical lab processing |
TC | Technical component | When the laboratory performs only the technical portion and the ordering provider bills only the technical component |
90 | Reference laboratory | When testing is performed by an outside/reference laboratory and billing reflects referral |
91 | Repeat clinical diagnostic laboratory test | When the same test is repeated on a subsequent specimen to verify results |
59 | Distinct procedural service | When this test is billed on the same day as another distinct laboratory procedure meeting documentation for separate service |
52 | Reduced services | When the test is partially reduced or not fully performed compared with the full service |
53 | Discontinued procedure | When testing is started but discontinued for reasons such as insufficient specimen |
90 | Reference laboratory | When testing is performed by an outside/reference laboratory and billing reflects referral |
QK | Medical direction of 2–4 clinical laboratory staff | When a physician provides medical direction consistent with CLIA/CMS rules (laboratory medical director roles) |
QX | Modifier for CLIA waived testing performed by a non-lab certified entity | When applicable regulatory modifiers apply to waived tests performed under specific provider arrangements |
SH | Diagnostic mammography — technical component (included here for lab networks billing multi-service panels) | Rarely used; included when bundled services require mammography-specific modifiers in a combined claim |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RH0000X | Rheumatology | Rheumatologists commonly order 86036 when evaluating vasculitis and autoimmune disease |
| 207K00000X | Allergy & Immunology | Specialists in immune-mediated disease order and interpret ANCA testing in clinical context |
| 2080P0206X | Pathology | Pathologists and clinical immunologists oversee laboratory testing and interpretation |
| 174400000X | Clinical Laboratory | Laboratory medicine specialists and clinical laboratory directors manage assay performance and reporting |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M31.3 | Wegener granulomatosis (granulomatosis with polyangiitis) | cANCA positivity supports this diagnosis and guides further management |
M31.7 | Microscopic polyarteritis and microscopic polyangiitis | pANCA patterns are commonly associated and assist in diagnosis |
N00.9 | Acute nephritic syndrome, unspecified | Hematuria with renal involvement prompts ANCA testing to evaluate vasculitic causes |
R82.70 | Abnormal urine test, unspecified | Abnormal urinary findings may trigger serologic evaluation including 86036 |
M35.3 | Polymyalgia rheumatica (included for differential autoimmune evaluation) | Autoimmune symptom overlap may prompt broader serologic panels including ANCA |
J82 | Pulmonary eosinophilia (example pulmonary involvement) | Pulmonary manifestations can occur in ANCA-associated vasculitis and warrant ANCA testing |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
80053 | Comprehensive metabolic panel | Routine chemistry panel often ordered concurrently to assess renal function when ANCA-associated vasculitis is suspected |
85025 | Complete blood count (CBC) with automated differential | Ordered alongside to evaluate for anemia, leukocytosis, or other hematologic abnormalities that accompany systemic inflammation |
83970 | Drug assay, qualitative; immunoassay | Sometimes ordered in parallel when medication effects or toxicities need exclusion during diagnostic workup |
88305 | Surgical pathology, gross and microscopic examination | If tissue biopsy (e.g., renal or nasal biopsy) is obtained to confirm vasculitis, pathology reporting is billed separately |
86769 | Antibody; tissue transglutaminase, IgA (example immunology panel code) | Represents additional immunology tests that may be ordered in autoimmune workups alongside ANCA testing |