CPT 86255Laboratory

Fluorescent antibody screen

CPT code 86255 covers a fluorescent antibody screening test, a laboratory technique that uses fluorescent dyes to detect specific antibodies in a patient's blood sample. This test helps identify immune responses to various infections or autoimmune conditions.

Showing rates for

National Average

Base Medicare rate

$17.14

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.37

PE RVU (NF)

0.15

MP RVU

0.01

Total RVU

0.53

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Verify CLIA certification and complexity level before billing 86255, as this is a high-complexity test requiring specific laboratory accreditation
Impact: Prevents 100% claim denial and potential compliance issues; uncertified labs cannot bill this code
Bill only one unit of 86255 per screening panel regardless of number of slides examined; additional specific antibody identifications require different codes
Impact: Prevents overbilling denials and potential fraud flags; ensures accurate $17.14 reimbursement per test
Link appropriate ICD-10 diagnosis codes that support medical necessity for antibody screening, such as autoimmune disorders, connective tissue diseases, or infectious disease evaluation
Impact: Increases clean claim rate by 25-40%; unsupported diagnosis codes are primary denial reason for immunology tests
Do not bill 86255 with specific antibody titer codes (86256) on the same specimen unless distinct separate testing is documented
Impact: Prevents bundling denials and recoupment; screen-positive cases requiring titers should use 86256 instead
For Medicare patients, ensure the test meets reasonable and necessary criteria per LCD/NCD policies for immunology testing
Impact: Prevents medical necessity denials; approximately 15-20% of immunology test denials relate to LCD non-compliance
Document the specific antigen substrate and fluorescent technique used in laboratory records to support code selection during audits
Impact: Reduces audit risk and supports appeals; clear documentation can prevent 10-15% of post-payment audit recoupments

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Frequently asked questions

What is the 2025 Medicare reimbursement rate for CPT code 86255?

The 2025 Medicare national average reimbursement for CPT 86255 is $17.14 for both facility and non-facility settings. This rate is based on 0.53 total RVUs (0.37 work RVU, 0.15 practice expense RVU, 0.01 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

What does CPT code 86255 include in the laboratory procedure?

CPT 86255 includes a fluorescent antibody screening test using immunofluorescence microscopy to detect antibodies in patient serum. This is a qualitative screening test only and does not include specific antibody identification, titers, or quantitative analysis, which require separate codes.

Can I bill CPT 86255 and 86256 together for the same patient?

Generally no, you should not bill both codes for the same specimen on the same date. CPT 86255 is a screening test, while 86256 is for titer determination. If screening is positive and titer is needed, bill only 86256. Billing both may result in bundling denials unless clearly documented as separate specimens or distinct clinical indications.

What CLIA certification level is required to bill CPT code 86255?

CPT 86255 requires CLIA certification for high-complexity testing. Your laboratory must have a valid CLIA certificate authorizing high-complexity testing, qualified personnel (clinical laboratory scientists or equivalent), and appropriate quality control procedures documented before billing this code.

Which diagnosis codes support medical necessity for CPT 86255?

Common supporting diagnoses include M32.9 (systemic lupus erythematosus), M35.9 (systemic connective tissue disorder), R76.0 (raised antibody titer), and various infection codes requiring antibody screening. The specific diagnosis must demonstrate clinical necessity for fluorescent antibody screening based on patient presentation and symptoms.

How many RVUs is CPT code 86255 worth in 2025?

CPT 86255 has 0.53 total RVUs in 2025, comprised of 0.37 work RVUs, 0.15 practice expense RVUs (both facility and non-facility), and 0.01 malpractice RVUs. These values are from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.

What is the difference between CPT 86255 and other fluorescent antibody codes?

CPT 86255 is specifically for screening purposes using fluorescent antibody techniques. Code 86256 is for fluorescent antibody titer, providing quantitative results. Other codes in the 86255-86256 range may specify different methodologies or specific antigens. Always select the code that most accurately describes the specific test performed and level of analysis.