Summary & Overview

CPT 86592: Syphilis Nontreponemal Antibody Test (RPR/ART/VDRL)

CPT code 86592 represents a nontreponemal serologic screening test for syphilis—commonly performed as RPR, ART, or VDRL—to detect reagin antibodies in patient specimens. This screening code is nationally relevant because syphilis testing is a routine component of sexually transmitted infection (STI) screening, prenatal care, blood donor screening, and diagnostic evaluation for symptomatic patients, influencing public health surveillance and clinical workflows.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for nontreponemal testing, expected sites of service (clinical and hospital laboratories), and common billing considerations tied to laboratory workflows. The publication provides benchmarks for utilization and payment patterns, common modifier usage, and notes on coding relationships to other syphilis testing modalities.

The content also outlines policy updates that affect laboratory reimbursement and documentation expectations at the national level, and it clarifies distinctions between screening nontreponemal tests and confirmatory treponemal methods. Data not available in the input is noted where applicable; the focus remains on operational and coding clarity for payers, laboratory managers, and billing staff.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare86592CPTSyphilis testingNontreponemal testRPRVDRLLaboratorySTI screening

Billing Code Overview

CPT code 86592 describes a laboratory procedure to detect syphilis-related antibodies using nontreponemal antigen tests, such as rapid plasma reagin (RPR), automated reagin test (ART), or the Venereal Disease Research Laboratory (VDRL) test. The procedure is a serologic screening method performed by a laboratory analyst to identify the presence of reagin antibodies that suggest active or recent infection.

Service type: Laboratory serologic screening for syphilis (nontreponemal tests)

Typical site of service: Clinical laboratory or hospital laboratory

Clinical & Coding Specifications

Clinical Context

A 28-year-old sexually active patient presents to a community health clinic for routine sexually transmitted infection (STI) screening after a new partner reports a recent positive syphilis test. The clinician documents a history of possible exposure and either orders a point-of-care or laboratory-based non-treponemal serologic screening. A phlebotomist collects a serum specimen; the laboratory analyst performs a non-treponemal reagin test such as the rapid plasma reagin (RPR) or Venereal Disease Research Laboratory (VDRL) test under code 86592. Results are reported to the ordering clinician and entered in the electronic medical record. If the non-treponemal test is reactive, reflex testing with treponemal-specific assays (for example treponemal chemiluminescent immunoassay) is commonly performed to confirm infection and guide management. Typical sites of service include outpatient clinics, public health or sexual health clinics, urgent care centers, and hospital laboratories. Typical timeframe from specimen collection to result ranges from same-day for point-of-care RPR to 24–72 hours for automated laboratory processing.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician/specialist interpretation of the test if separated from the technical component.
`TC`	Technical component	Use when billing only the laboratory technical component (performing the assay, specimen processing).
`59`	Distinct procedural service	Use when this lab test is separately reportable and distinct from other procedures on the same day.
`90`	Reference (outside) laboratory	Use when the specimen is sent to an outside reference laboratory for processing.
`91`	Repeat clinical diagnostic laboratory test	Use when the same test is repeated on the same day for verification or monitoring.
`52`	Reduced services	Use when the laboratory performs a reduced or partial version of the test.
`53`	Discontinued procedure	Use when testing was started but discontinued for documented medical reasons.
`QW`	CLIA-waived test	Use when the test meets CLIA-waived status and payor requires the modifier for billing.
`90`	Duplicate entry (covered above)	Duplicate of `90` removed in selection — see above.
`59`	Duplicate entry (covered above)	Duplicate of `59` removed in selection — see above.

Taxonomy Code	Specialty	Notes
207Q00000X	Pathology & Laboratory Medicine	Clinical laboratory directors and pathologists overseeing serologic testing.
208D00000X	General Practice	Primary care clinicians ordering STI screening tests.
208000000X	Family Medicine	Family physicians who order and interpret syphilis screening.
363LF0000X	Infectious Disease	Specialists consulted for complex or confirmed syphilis cases.
3336C0006X	Public Health & Preventive Medicine	Providers in public health clinics conducting screening programs.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`A53.9`	Syphilis, unspecified	Common indication for non-treponemal screening with `86592`.
`A53.0`	Early syphilis, primary	Non-treponemal tests assist initial screening and monitoring.
`A53.1`	Early syphilis, secondary	Used for diagnosis and treatment response monitoring.
`A54.02`	Gonococcal infection of lower genitourinary tract	Often screened concurrently during STI workups.
`Z11.3`	Encounter for screening for infections with a predominantly sexual mode of transmission	Typical encounter code when ordering syphilis screening.
`O98.81`	Syphilis complicating pregnancy, unspecified	Maternal screening is standard; non-treponemal test used in prenatal care.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`86780`	Treponema pallidum antibody, confirmatory, qualitative or semiquantitative (e.g., FTA-ABS, TP-PA)	Used as a confirmatory treponemal-specific test when `86592` (non-treponemal) is reactive.
`87622`	Infectious agent detection by nucleic acid (e.g., syphilis NAAT)	Performed in some settings for direct detection or when additional molecular testing is indicated.
`36415`	Collection of venous blood by venipuncture	Often billed when blood is drawn for the `86592` assay if separately reportable.
`99000`	Handling and/or conveyance of specimen	May be used by some facilities for specimen handling; check payor rules for applicability.
`G0480`	Lead screening — not directly related but example of lab screening code	Data not available in the input.