Summary & Overview
CPT 86255: Fluorescent Immunoassay Antibody Screening
CPT code 86255 represents a laboratory immunoassay screening test that uses a fluorescent method to detect antibodies to noninfectious agents in blood, typically serum. As a qualitative screen, results report presence or absence rather than numeric titers. This code matters nationally because immunoassay screening is widely used in clinical diagnostics, blood donor screening, and pre-procedural evaluations; accurate coding affects clinical workflows, laboratory billing, and payer coverage determinations across public and private plans.
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 the test, typical sites of service and specimen types, and what to expect in terms of coding classification. The publication outlines common modifiers and identifies missing input fields where relevant (for example, specific associated taxonomies and ICD-10 diagnoses are not provided). This resource also orients readers to how CPT code 86255 fits among laboratory immunoassay services and what elements are typically considered by payers and providers when processing claims.
Billing Code Overview
CPT code 86255 describes a qualitative immunoassay screening test that detects antibodies to a noninfectious agent using a fluorescent method. The result is reported in a qualitative form (for example, positive or negative) rather than as a numeric concentration.
Service type: Immunoassay screening — fluorescent antibody detection
Typical site of service: Clinical laboratory or hospital laboratory; specimens are usually blood (serum) collected in an outpatient or inpatient setting.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an outpatient laboratory or hospital laboratory for screening of a noninfectious antibody using a fluorescent immunoassay. For example, a rheumatology patient with suspected autoimmune disease has a blood draw (serum) ordered to screen for a specific autoantibody using a fluorescent immunoassay technique. The clinician orders the test, phlebotomy obtains the sample, the specimen is processed in the clinical lab, and a medical laboratory scientist or technologist performs the immunoassay. Results are reported qualitatively (e.g., positive/negative) to the ordering provider who integrates the screen with clinical findings and may order confirmatory or reflex testing if indicated. Typical sites of service include outpatient hospital laboratory, independent clinical laboratory, and ambulatory clinic laboratory services.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When only the professional interpretation of the test is reported separately from the technical component |
TC | Technical component | When only the technical component (laboratory processing) is billed |
59 | Distinct procedural service | When this immunoassay is a distinct service from other procedures on the same date |
90 | Reference (outside) laboratory | When the test is performed by an outside/reference laboratory |
91 | Repeat clinical diagnostic laboratory test | When a repeat test is needed to confirm a prior result on the same date |
52 | Reduced services | When the test is partially performed or limited in scope |
53 | Discontinued procedure | When testing was started but medically terminated before completion |
95 | Synchronous telemedicine service rendered via real-time interactive audio and video | If remote consultation drives ordering/interpretation (rare for lab tests) |
QW | CLIA waived test | When the assay is CLIA-waived and billed accordingly |
QX | Ordering/servicing physician is different than billing provider (modifier for PAMA) | When the ordering provider differs under applicable payer policies |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
LABDLM | Clinical Laboratory Scientist/Technologist | Performs and interprets immunoassays in the laboratory |
207R00000X | Rheumatology | Common ordering specialty for autoimmune antibody screening |
207L00000X | Allergy & Immunology | May order antibody screening for immune assessment |
208D00000X | Pathology | Oversees laboratory testing, quality control, and interpretation |
363LP0800X | Phlebotomy/Specimen Collection | Performs blood draws for the assay |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M35.3 | Polymyalgia rheumatica | Autoimmune/inflammatory conditions prompting antibody screening |
M32.9 | Systemic lupus erythematosus, unspecified | Common rheumatologic disorder for which antibody screens are ordered |
M05.9 | Rheumatoid arthritis with rheumatoid factor and rheumatoid nodule, unspecified | Autoimmune arthritis prompting autoantibody testing |
R53.83 | Other fatigue | Nonspecific symptom that may trigger broad lab screening including antibody assays |
Z51.89 | Encounter for other specified aftercare | Follow-up monitoring where screening immunoassays are used |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
36415 | Collection of venous blood by venipuncture | Phlebotomy required to obtain serum for the immunoassay |
80053 | Comprehensive metabolic panel | Common concurrent laboratory panel ordered during evaluation |
83516 | Immunoassay for drug(s) or toxin(s), quantitative or semi-quantitative; multiple drug classes | Different immunoassay method sometimes ordered alongside antibody screens |
88360 | Immunohistochemistry including cellular localization (per specimen) | Complementary laboratory testing when tissue or cellular localization is needed |
86038 | Antibody; quantitative (e.g., IgG, IgM), each reagent | Additional antibody testing when quantitative results are required |