Summary & Overview
CPT 86481: T‑Cell Interferon-Gamma Release Assay for Tuberculosis Antigens
CPT code 86481 covers a laboratory immunology assay that enumerates T cells producing interferon-gamma in response to tuberculosis-related antigens. This test is used to assess cell-mediated immune response to TB antigens and plays a role in diagnosing latent or active tuberculosis infection where interferon-gamma release assays are clinically indicated. Nationally, this code matters for public health screening programs, occupational health evaluations, and laboratory reimbursement policy due to growing use of targeted TB testing.
Key payers included in the coverage analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and commonly used billing modifiers. The publication provides benchmarking and policy-relevant information on coverage trends and reimbursement considerations for laboratories and billing professionals. It also outlines clinical implications of the assay and the operational settings where the test is performed.
Data not available in the input for payer-specific rates, associated taxonomies, and ICD-10 mappings. The report focuses on national-level policy and clinical context rather than state-specific rules.
Billing Code Overview
CPT code 86481 describes a laboratory test that evaluates an antigen-driven cellular immune response to tuberculosis-related antibodies by enumerating T cells that produce gamma interferon. The service is a specialized immunologic assay performed by a laboratory analyst to detect antigen-specific T‑cell production of interferon-gamma.
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Service type: Laboratory immunology service — T‑cell interferon-gamma release assay
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Typical site of service: Clinical laboratory or hospital laboratory setting
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or adolescent with suspected latent or active tuberculosis infection referred for interferon-gamma release assay (IGRA) testing. The patient presents to an outpatient clinic, occupational health clinic, public health department, or hospital lab phlebotomy station for blood draw. A clinician documents exposure history, risk factors (recent contact with infectious TB case, immunosuppression, healthcare worker screening, immigrant screening, or pre-biologic therapy evaluation), and orders IGRA testing. The specimen is collected via venipuncture, handled per manufacturer instructions (proper tube type, incubation or room temperature requirements), and transported to the laboratory. In the laboratory, a trained technologist incubates patient blood with TB-specific antigens and measures T‑cell production of interferon-gamma, typically using enzyme-linked immunosorbent assay (ELISA) or similar platforms. Results are reported as positive, negative, or indeterminate and routed back to the ordering clinician for interpretation relative to clinical history, prior Bacille Calmette-Guérin (BCG) vaccination, and risk factors.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the professional interpretation of the test result by a physician or qualified provider separate from the technical component. |