Summary & Overview
CPT 86580: Intradermal Tuberculosis Skin Test
CPT code 86580 denotes an intradermal skin test performed to detect tuberculosis exposure. Nationally, this code represents a common public health and occupational screening procedure used in outpatient clinics, public health departments, and occupational health settings. Accurate coding of this test is important for surveillance, reimbursement tracking, and ensuring appropriate documentation of preventive and diagnostic services.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, information on typical sites of service, and an explanation of why the code matters for billing workflows and capture of TB screening activity. The publication also covers typical payer coverage considerations, common billing modifiers used with procedure codes (list provided), and where to look for supporting diagnosis documentation.
This summary provides a national overview useful for billing staff, clinicians ordering TB screening, and administrators who manage outpatient and occupational health services. Data not available in the input prevents inclusion of payer-specific reimbursement benchmarks or state-level policy variations.
Billing Code Overview
CPT code 86580 describes an intradermal skin test for tuberculosis administered by a laboratory analyst. The service involves placement of a purified protein derivative (PPD) or other tuberculin preparation intradermally to evaluate for a delayed hypersensitivity reaction indicating prior Mycobacterium tuberculosis exposure.
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Service type: Diagnostic skin testing procedure
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Typical site of service: Outpatient clinic, public health clinic, occupational health clinic, or laboratory setting where intradermal skin tests are performed
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or pediatric patient presenting to an outpatient clinic, community health center, occupational health clinic, or public health department for tuberculosis screening or evaluation after exposure. The clinician documents risk factors (recent exposure to active pulmonary tuberculosis, prior positive TB test, immunosuppression, healthcare or congregate setting employment) and orders an intradermal tuberculin skin test (TST) using purified protein derivative (PPD). A licensed provider or trained nurse administers the intradermal injection on the volar surface of the forearm, records the lot number and administration site, and instructs the patient to return in 48–72 hours for measurement. At the follow-up visit, the provider measures transverse induration (not erythema), documents millimeters of induration, and interprets results relative to risk category. The workflow may include counseling, documentation of prior Bacillus Calmette–Guérin (BCG) vaccination, and ordering confirmatory testing such as chest radiograph if the test is positive or if clinical suspicion is high. Billing uses 86580 for the intradermal skin test procedure performed by the laboratory or clinician responsible for the test application and/or measurement per payer rules.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service | Use when a separate E/M is provided on the same day as the TST and meets E/M documentation criteria. |