Summary & Overview
CPT 86341: Islet Cell Antibody Test for Type 1 Diabetes
CPT code 86341 designates an immunology laboratory assay that detects and measures islet cell antibodies in patient blood, most commonly used to differentiate type 1 diabetes from type 2 diabetes and to guide endocrine disorder management. Nationally, this code supports diagnostic workflows that influence treatment decisions, enrollment in diabetes management programs, and eligibility for certain specialty services.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the test, typical sites of service, payer coverage considerations, and commonly associated billing modifiers. The publication outlines benchmarks for utilization and reimbursement patterns where available and summarizes relevant policy or coverage updates that affect laboratory-based autoimmune testing.
This analysis is intended for clinicians, laboratory managers, and billing professionals seeking a national overview of the clinical purpose, billing considerations, and payer landscape for CPT code 86341. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 86341 reports a laboratory test that measures islet cell antibodies in a patient blood specimen collected by routine venipuncture. The analysis detects and quantifies islet cell antibodies used in the evaluation and management of type 1 diabetes and other endocrine disorders where autoimmune processes are suspected.
Service Type: Immunology / Clinical Laboratory Testing
Typical Site of Service: Clinical laboratory or hospital outpatient phlebotomy/collection site
Clinical & Coding Specifications
Clinical Context
A 12-year-old patient presents to a pediatric endocrine clinic with recent rapid-onset polyuria, polydipsia, weight loss and mild diabetic ketoacidosis. The endocrinologist orders an islet cell antibody panel to differentiate autoimmune type 1 diabetes from type 2 diabetes and to guide initial management. A phlebotomy technician performs routine venipuncture in the outpatient laboratory, labels and processes the blood specimen, and the clinical laboratory analyst runs the immunoassay for islet cell antibodies (ICAs). Results are reviewed by the ordering provider to confirm autoimmune etiology, inform patient education, and assess need for additional antibody testing (for example, GAD65 or IA-2 antibodies). Typical site of service is an outpatient hospital laboratory, independent reference laboratory, or outpatient clinic laboratory. The specimen collection is standard venipuncture with routine processing; testing is billed as a clinical laboratory service for immunologic antibody measurement using 86341.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician interpretation component separate from the technical lab component, if applicable by payer. |
TC |