Summary & Overview
CPT 86320: Immunoelectrophoresis of Serum Immunoglobulins
CPT code 86320 represents immunoelectrophoresis (IEP), a laboratory diagnostic assay used to separate and characterize immunoglobulins in a patient’s serum. IEP is clinically important for detecting abnormal monoclonal or polyclonal protein patterns, supporting diagnoses such as monoclonal gammopathies, multiple myeloma workups, and immune status evaluations. As a specialized immunology/serology test, it is performed in clinical and hospital laboratories and factors into laboratory service utilization and coverage determinations nationally.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines how CPT code 86320 is billed across these major payers, common modifier usage, and typical sites of service. Readers will find context on clinical indications for immunoelectrophoresis, the laboratory service classification, and how this code fits into diagnostic testing workflows.
This summary provides benchmarks and policy-relevant information for laboratory administrators, billing professionals, and payers, along with clinical context to understand when CPT code 86320 is applied. Data not available in the input is explicitly noted where applicable in detailed sections.
Billing Code Overview
CPT code 86320 describes immunoelectrophoresis (IEP) performed on a patient’s serum to evaluate the amounts and types of immunoglobulins (antibodies). The procedure separates serum proteins and identifies specific immunoglobulin patterns to aid in the assessment of immune status and in the detection of monoclonal gammopathies or other protein abnormalities.
Service Type: Laboratory diagnostic test — immunology/serology
Typical Site of Service: Clinical laboratory or hospital laboratory
Clinical & Coding Specifications
Clinical Context
A typical scenario involves an adult outpatient referred by a primary care physician or hematologist for evaluation of a suspected gammopathy. The patient presents with unexplained anemia, recurrent infections, hypercalcemia, bone pain, or an abnormal serum protein/total protein or electrophoresis screen. A venous blood specimen is collected in the phlebotomy area and sent to the clinical laboratory. The laboratory technologist performs serum immunoelectrophoresis (86320) to separate and identify immunoglobulin classes and abnormal monoclonal bands. Results are reported to the ordering clinician and used alongside serum protein electrophoresis, quantitative immunoglobulin levels, and clinical findings to diagnose monoclonal gammopathy, multiple myeloma, Waldenström macroglobulinemia, or immune deficiency states. Typical sites of service include hospital outpatient laboratories, independent clinical reference laboratories, and hospital inpatient laboratories when inpatient evaluation is required.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the professional interpretation component and the laboratory bills separately for technical work |
TC |