Summary & Overview
CPT 86334: Immunofixation Electrophoresis for Monoclonal Gammopathies
CPT code 86334 represents immunofixation electrophoresis, a laboratory diagnostic assay used to detect and characterize monoclonal immunoglobulins for diagnosis and monitoring of monoclonal gammopathies, including multiple myeloma. Nationally, this code matters because it supports diagnosis, disease tracking, and therapeutic decision-making for hematologic malignancies and paraproteinemias, with implications for laboratory utilization, reimbursement policy, and clinical pathways.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context and typical settings of service, a summary of payer coverage patterns and coding considerations, and benchmarking and policy-relevant insights where available. The content addresses common billing modifiers and related administrative considerations provided in the input.
This publication is intended to inform coders, lab managers, and policy analysts about the clinical purpose of the test, typical sites of service, and the payer landscape relevant to CPT code 86334. Data not available in the input are noted where applicable; the focus remains on explaining what the code represents and how it is used in clinical and billing workflows.
Billing Code Overview
CPT code 86334 describes immunofixation electrophoresis performed by a laboratory analyst, typically on the patient’s serum, to diagnose and/or monitor monoclonal gammopathies such as multiple myeloma. This test identifies and characterizes monoclonal immunoglobulins and aids in the clinical evaluation of suspected plasma cell disorders.
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Service type: Laboratory diagnostic assay (immunohematology/serology)
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Typical site of service: Clinical laboratory or hospital laboratory, with specimen collection commonly performed in outpatient phlebotomy or inpatient hospital settings.
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Clinical & Coding Specifications
Clinical Context
A 62-year-old outpatient with progressive anemia, renal insufficiency, hypercalcemia, and unexplained bone pain is referred to hematology for evaluation of a suspected monoclonal gammopathy. The clinician orders serum protein electrophoresis followed by immunofixation electrophoresis to characterize and confirm a monoclonal (M) protein. A phlebotomist draws a serum sample in the ambulatory clinic; the specimen is transported to the clinical laboratory. A medical technologist performs immunofixation electrophoresis (86334) on the serum to identify immunoglobulin heavy- and light-chain isotypes (for example, IgG kappa). Results are reported to the ordering hematologist for diagnostic correlation, staging, and treatment planning. Typical sites of service include hospital outpatient laboratories, independent reference laboratories, and ambulatory clinic laboratories when specimen processing is performed onsite. The workflow commonly follows: order entry → specimen collection → specimen accessioning → electrophoresis and immunofixation assay → interpretive review by a qualified laboratory physician or pathologist → result reporting to the ordering provider.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation component (pathologist/physician interpretation) of the test. |