Summary & Overview
CPT 86340: Intrinsic Factor Antibody Test
CPT code 86340 designates a serologic assay for intrinsic factor antibodies, a diagnostic test used to evaluate autoimmune gastritis and pernicious anemia by detecting antibodies that interfere with vitamin B12 absorption. Nationally, this test is clinically relevant for immunologic workups of unexplained macrocytic anemia and B12 deficiency and influences downstream diagnostic and treatment decisions.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis covers payer coverage considerations and common billing practices related to laboratory testing for intrinsic factor antibodies.
Readers will find a concise clinical context for CPT code 86340, typical sites of service, and an outline of billing details such as common modifiers. The publication summarizes what to expect in payer interactions, highlights common areas of coverage variation, and provides benchmarks and policy-relevant notes where available. Data not provided in the input are noted as unavailable.
Billing Code Overview
CPT code 86340 describes a laboratory test that measures intrinsic factor antibodies in a patient specimen, typically blood. This assay is used in evaluating suspected autoimmune gastritis and pernicious anemia by detecting antibodies that target intrinsic factor, a protein required for vitamin B12 absorption.
Service Type: Serologic laboratory test
Typical Site of Service: Clinical laboratory or hospital laboratory, with specimen collection often performed in an ambulatory clinic or phlebotomy setting.
Data not available in the input for payers, associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient presents with progressive fatigue, pallor, and glossitis. Laboratory evaluation shows macrocytic anemia with elevated mean corpuscular volume (MCV) and low serum vitamin B12. The clinician suspects pernicious anemia due to autoimmune destruction of gastric parietal cells and orders serologic testing, including intrinsic factor antibody measurement. A phlebotomy is performed in an outpatient laboratory or hospital draw station; the blood specimen is sent to the clinical immunology laboratory where an automated or manual immunoassay detects and quantifies intrinsic factor antibodies. Results are reported to the ordering provider, who integrates the antibody result with vitamin B12 level, methylmalonic acid, and clinical findings to establish a diagnosis and guide treatment (for example, B12 replacement). Typical sites of service are hospital outpatient laboratory, independent clinical laboratory, or physician office laboratory. The service type is a diagnostic laboratory immunology test.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the professional interpretation component if the laboratory or physician bills separately for interpretation. |
TC |