Summary & Overview
CPT 86225: Anti–dsDNA Antibody Assay
CPT code 86225 represents a laboratory immunology assay to detect native or double‑stranded DNA (dsDNA) antibodies in patient serum. This test is clinically important for the evaluation and monitoring of autoimmune diseases where anti‑dsDNA antibodies are relevant, and it is commonly ordered by rheumatology, nephrology, and primary care clinicians. Nationally, CPT code 86225 is a standard laboratory service used across hospital and independent clinical laboratory settings and factors into utilization and laboratory billing patterns.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for the assay, typical sites of service, common modifiers associated with laboratory billing, and the payers that commonly cover the test. The publication summarizes benchmark pricing and utilization considerations, highlights relevant billing and coding nuances for laboratories, and outlines where to find supporting clinical and billing resources.
This summary is intended to provide a concise national view of CPT code 86225, helping clinical laboratory managers, billing professionals, and policy analysts understand the code’s clinical purpose, typical use settings, and payer landscape. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 86225 describes a laboratory assay performed by a lab analyst to evaluate a patient’s serum for antibodies to native or double–stranded deoxyribonucleic acid (dsDNA), also called native anti–DNA or dsDNA antibody. This test is used to detect antibodies that can be associated with autoimmune conditions and is a serologic immunology assay.
-
Service type: Laboratory immunology assay
-
Typical site of service: Clinical laboratory or hospital laboratory setting
Clinical & Coding Specifications
Clinical Context
A 32-year-old woman with a history of intermittent arthralgias, photosensitivity, and new onset proteinuria is assessed in a rheumatology clinic. Her clinician suspects systemic lupus erythematosus (SLE) and orders serologic testing including antinuclear antibody (ANA) and anti–double stranded DNA (anti-dsDNA) to support diagnosis and assess disease activity. A phlebotomy technician draws a serum specimen which is labeled and sent to the laboratory. A medical laboratory scientist performs the assay described by 86225 (anti–native or double–stranded DNA antibody) using an immunoassay or Farr assay platform. Results are reviewed by the laboratory analyst, entered into the laboratory information system, and reported to the ordering clinician. The clinician uses the anti-dsDNA result together with clinical findings and other serologies to support diagnosis, guide immunosuppressive therapy decisions, and monitor disease activity over time.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the professional interpretation portion if the lab component is billed separately. |
TC |