Summary & Overview
CPT 86258: Gliadin (deamidated) Antibody (DGP) Serology
CPT code 86258 represents a laboratory immunoassay for antibodies to deamidated gliadin peptides (DGP IgG and/or DGP IgA). This serologic test is clinically relevant for diagnosing celiac disease and for monitoring adherence to gluten‑free therapy. Nationally, DGP antibody testing is part of the diagnostic and follow‑up toolkit for clinicians evaluating suspected or confirmed celiac disease, and it has implications for laboratory billing, coverage determinations, and care pathways.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what CPT code 86258 covers, typical sites of service, and the clinical context for ordering the test. The publication summarizes common payer considerations and coverage themes, benchmarking points, and any notable policy updates or documentation expectations where available. It also outlines coding relationships and clinical indications tied to serologic testing for celiac disease. Data not available in the input: associated taxonomies, ICD‑10 diagnoses, related codes, and service line specifics.
Billing Code Overview
CPT code 86258 describes a laboratory immunoassay performed to detect an antibody to gliadin (deamidated) (DGP), such as DGP IgG or DGP IgA, in a clinical specimen (for example, serum). The presence of DGP antibodies assists in the diagnosis of celiac disease, an autoimmune condition that inflames the small intestine in response to dietary gluten, and can help clinicians monitor patient adherence to gluten‑free treatment.
Service type: Laboratory immunoassay serology test
Typical site of service: Clinical laboratory or hospital laboratory; specimens commonly collected in outpatient clinics, physician offices, or hospital outpatient settings
Clinical & Coding Specifications
Clinical Context
A 28-year-old patient presents to a gastroenterology clinic with several months of intermittent diarrhea, bloating, unexplained iron-deficiency anemia, and weight loss. The gastroenterologist suspects celiac disease. Initial evaluation includes a clinical history, physical exam, and serologic testing. A blood sample is sent to the laboratory for an immunoassay to detect antibodies to deamidated gliadin peptides (DGP), such as DGP IgA and DGP IgG, billed with 86258.
The typical workflow: the clinician orders the DGP antibody test when celiac disease is suspected or when monitoring adherence to a gluten‑free diet in a previously diagnosed patient. A phlebotomy draw is performed in the outpatient clinic or an ambulatory laboratory. The specimen (serum) is transported to the lab; testing is performed via ELISA or similar immunoassay. Results are reported in the electronic health record to the ordering provider. Positive DGP IgA and/or IgG results support further evaluation for celiac disease, often paired with total serum IgA, tissue transglutaminase antibodies, and, where indicated, referral for duodenal biopsy. Typical sites of service include outpatient physician offices, ambulatory laboratory centers, and hospital outpatient laboratories. Service type: laboratory diagnostic immunoassay.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the professional component of a diagnostic lab test is billed separately by a physician/provider. |