Summary & Overview
CPT 86386: Urine Assay for Nuclear Matrix Protein 22 (NMP22)
CPT code 86386 represents a laboratory assay for nuclear matrix protein 22 (NMP22) measured in urine, a noninvasive biomarker used in the assessment of urothelial carcinoma. Nationally, this test informs clinical decision-making around bladder cancer evaluation and surveillance and can affect diagnostic pathways and resource use across outpatient and hospital laboratory settings. Major payers have varying coverage policies for urinary tumor marker assays; this publication summarizes payer approaches and national benchmarks relevant to utilization and coding.
Key payers covered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of how CPT code 86386 is defined clinically, common sites of service, and payer coverage landscape. The report also outlines coding context and practical billing considerations, summarizes utilization benchmarks where available, and highlights policy updates or payment guidance that affect laboratory and outpatient practices. Data not available in the input will be noted as such where applicable.
Billing Code Overview
CPT code 86386 describes a laboratory test performed to detect elevated levels of nuclear matrix protein 22 (NMP22) in patient urine. This assay is used as a noninvasive biomarker test to help assess for urothelial carcinoma activity by measuring NMP22 concentration in a urine specimen.
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Service type: Laboratory diagnostic test
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Typical site of service: Clinical laboratory or hospital laboratory, with specimen collection commonly performed in outpatient clinics or physician offices
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an outpatient urology clinic with hematuria, urinary frequency, or a history of non–muscle invasive bladder cancer requiring surveillance. The clinician collects a urine specimen during the visit; the specimen is sent to the clinical laboratory where a lab analyst performs a protein-based immunoassay to detect elevated levels of nuclear matrix protein 22 (NMP22) in urine. Results are reported to the ordering urologist. Positive or elevated NMP22 may prompt cystoscopy, urine cytology, imaging, or enhanced surveillance; negative results may be documented and used alongside clinical assessment to determine next steps. Typical site of service is an outpatient clinic or hospital outpatient laboratory; testing may also occur in an independent clinical laboratory with specimen collection at the clinic or ambulatory surgical center.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard usage when no service-specific modifier applies |
11 | Office or other outpatient E/M service by the physician | When the physician performs an evaluation and management on the same date relevant to billing rules |