Summary & Overview
CPT 86215: Immunoassay for Anti–DNase Antibodies in Serum
CPT code 86215 denotes an immunoassay performed on serum to detect antibodies to deoxyribonuclease (anti–DNase). This serologic test aids clinical evaluation for infectious and autoimmune conditions where anti–DNase antibodies are relevant. Nationally, serologic assays like this are part of laboratory diagnostic workflows that inform clinical decisions and downstream care.
Key payers considered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical purpose and typical laboratory setting for CPT code 86215, along with payer coverage context. The publication outlines expected benchmarks for utilization and reimbursement where available, summarizes relevant coding and billing considerations, and provides clinical context to help clinical laboratories and billing staff categorize the service correctly.
The analysis emphasizes practical information: what the code represents, typical sites of service, and how major payers approach coverage. Data not provided in the input—such as specific reimbursement rates, associated taxonomies, and ICD-10 mappings—is noted as unavailable. The section that follows provides a focused overview for quick reference by billing professionals and laboratory managers.
Billing Code Overview
CPT code 86215 represents an immunoassay for antibodies to deoxyribonuclease (anti–DNase) performed on a patient’s serum. The test is used to detect antibodies directed against DNase, commonly ordered as part of serologic evaluation for certain infectious or autoimmune conditions.
Service Type: Immunoassay / Serologic antibody testing
Typical Site of Service: Clinical laboratory or hospital laboratory
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A common scenario involves an outpatient adult or pediatric patient with suspected post-streptococcal immune phenomena (for example, rheumatic fever or post-streptococcal glomerulonephritis), or a patient under evaluation for a recent streptococcal infection when antibody profiling is needed. A phlebotomist collects a serum specimen at an ambulatory laboratory, hospital outpatient phlebotomy area, or inpatient unit. The sample is sent to the clinical immunology or microbiology laboratory where a medical laboratory scientist or lab analyst performs an immunoassay for anti–DNase (deoxyribonuclease) antibodies. Test results are interpreted by laboratory staff and reported to the ordering clinician (primary care physician, pediatrician, infectious disease specialist, rheumatologist, or nephrologist) to help confirm recent streptococcal exposure or post-infectious immune response. Typical site of service: outpatient laboratory, hospital outpatient department, or inpatient clinical laboratory. Service type: laboratory immunoassay/serology test.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional component for interpretation if the laboratory and physician bill separately. |
59 | Distinct procedural service | Use when the immunoassay is a distinct service from another performed test on the same day that would otherwise be bundled. |
91 | Repeat clinical diagnostic laboratory test | Use when the same anti‑DNase test is repeated on the same day to confirm prior questionable results. |
90 | Reference (outside) laboratory | Use when the specimen is sent to an outside reference laboratory for testing. |
TC | Technical component | Use when billing only the technical component (laboratory processing and equipment) separate from professional interpretation. |
91 | (Note: 91 already listed) | (See above) |
52 | Reduced services | Use when the laboratory performs a limited/smaller scope version of the assay. |
53 | Discontinued procedure | Use if specimen collection or testing was started but discontinued for documented clinical reasons. |
90 | (Note: 90 already listed) | (See above) |
59 | (Note: 59 already listed) | (See above) |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 1223P0001X | Clinical Laboratory | Laboratory-based specialists performing serologic testing and reporting. |
| 207RN0400X | Internal Medicine | Ordering physicians who commonly request anti‑DNase testing for post‑streptococcal conditions. |
| 208000000X | Pediatrics | Pediatricians ordering testing for suspected streptococcal sequelae in children. |
| 207R00000X | Infectious Disease | Specialists who interpret serologies in complex infections. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
J02.9 | Acute pharyngitis, unspecified | Pharyngitis caused by Streptococcus pyogenes can trigger an antibody response measured by anti‑DNase. |
M35.1 | Acute rheumatic fever | Post‑streptococcal immune sequela; anti‑DNase helps document recent streptococcal exposure in clinical evaluation. |
N00.9 | Acute nephritic syndrome, unspecified | Post‑streptococcal glomerulonephritis is assessed with streptococcal serologies including anti‑DNase. |
G00.8 | Other bacterial meningitis | In rare invasive streptococcal infections serology may be adjunctive; included for completeness in complex cases. |
R50.9 | Fever, unspecified | Nonspecific symptom prompting evaluation for recent infection including streptococcal serologies. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
86789 | Antistreptococcal antibody; other (e.g., anti–streptolysin O) | Often ordered alongside anti‑DNase to assess recent streptococcal infection and to provide complementary serologic information. |
87070 | Culture, bacterial; any source, aerobic with isolation and presumptive identification of isolates | May be ordered to obtain a throat or wound culture when active streptococcal infection is suspected prior to serologic testing. |
86580 | Skin test; tuberculosis, intradermal (Mantoux) | Not directly related clinically but represents other immunologic testing that may be ordered in diagnostic workups; included here as another immunologic test commonly performed in outpatient settings. |
80053 | Comprehensive metabolic panel | Frequently ordered in parallel to evaluate systemic involvement when post‑infectious conditions are suspected. |
86592 | Allergic testing; percutaneous tests | Represents other immunologic laboratory services sometimes performed in immunology workflows. |