Summary & Overview
CPT 86430: Rheumatoid Factor (RF) Test, Serologic Assay
CPT code 86430 represents a laboratory serologic assay for rheumatoid factor (RF), a common biomarker used in evaluating suspected rheumatoid arthritis and related autoimmune disorders. Nationally, RF testing remains a routine diagnostic aid in rheumatology and primary care, supporting clinical diagnosis, disease characterization, and monitoring when combined with clinical evaluation and other tests. The code captures the laboratory technical work required to detect RF in patient serum.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise reference for billing and clinical teams on how 86430 is classified and where the service is typically performed.
Readers will learn the clinical context for ordering RF testing, typical sites of service such as hospital and independent clinical laboratories, and operational considerations relevant to billing and coding workflows. Where specific data elements were not provided in the input, the summary notes that those items are not available. The piece is intended as a national-level overview for payers, providers, and coding professionals seeking clear, actionable information about CPT code 86430 and its role in laboratory diagnostics.
Billing Code Overview
CPT code 86430 reports a laboratory test performed to detect the presence of rheumatoid factor (RF) in a patients blood. This is an immunoassay used to identify autoantibodies commonly associated with rheumatoid arthritis and other autoimmune conditions.
Service type: Laboratory diagnostic test (serology)
Typical site of service: Clinical laboratory or hospital laboratory
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to primary care or rheumatology with joint pain, morning stiffness, symmetric small joint swelling, or systemic symptoms suggesting inflammatory arthritis. The clinician orders a rheumatoid factor test to aid in the evaluation. A phlebotomy technician draws blood in an outpatient laboratory or hospital inpatient setting. The specimen is processed by the clinical laboratory; a technologist performs an immunoassay or nephelometry to detect and quantify rheumatoid factor (RF) in serum. Results are reported to the ordering provider and used in conjunction with clinical findings, inflammatory markers, and imaging to support diagnoses such as rheumatoid arthritis, other autoimmune connective tissue diseases, or to help differentiate seropositive versus seronegative disease. Typical sites of service include outpatient physician offices with draw stations, independent clinical laboratories, hospital outpatient labs, and inpatient hospital laboratories. The service type is a laboratory diagnostic immunoassay performed by a clinical laboratory under the supervision of a laboratory director.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the professional interpretation component if applicable in a composite service scenario for lab procedures with separate professional reporting. |