CPT 86320Laboratory

Serum immunoelectrophoresis

CPT code 86320 covers serum immunoelectrophoresis, a specialized lab test that separates and identifies proteins in blood serum to detect abnormal antibodies or protein disorders. This test is commonly ordered to diagnose conditions like multiple myeloma, immune deficiencies, or other protein abnormalities.

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 medical necessity documentation before billing - ensure ICD-10 codes support the need for immunoelectrophoresis rather than standard protein electrophoresis
Impact: Prevents denials for lack of medical necessity; inappropriate orders for routine protein screening commonly denied, potentially affecting 15-25% of claims without proper diagnosis linkage
Do not bill 86320 on the same date as 84165 (serum protein electrophoresis) without clear documentation of medical necessity for both tests
Impact: Many payers consider 86320 an inclusive follow-up to 84165; billing both may result in bundling denials reducing payment by $17.14 if 86320 is denied
Confirm CLIA certification and high-complexity testing approval before performing; maintain QC and proficiency testing records for audit protection
Impact: Performing without proper CLIA certification can result in 100% claim denial plus potential civil monetary penalties up to $10,000 per violation
Bill the date of service as the specimen collection date, not the date results are reported or interpreted
Impact: Incorrect dating causes processing delays and potential timely filing denials; establishes proper claim sequence when billed with collection codes
When ordering physician and performing laboratory are different entities, ensure proper ABN (Advance Beneficiary Notice) is obtained if medical necessity is questionable
Impact: Without valid ABN, laboratory cannot collect from patient if Medicare denies; protects against write-offs averaging $17.14 per denied claim
Submit with specific ICD-10 codes for plasma cell disorders (C90.x), immunodeficiency (D80-D84), or abnormal immunological findings (R79.1) rather than screening codes

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 86320 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 86320 is $17.14 for both facility and non-facility settings. This rate is based on 0.53 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on the GPCI adjustments in your area.

What is the difference between CPT 86320 and 84165?

CPT 84165 (serum protein electrophoresis) separates proteins into general groups (albumin, alpha-1, alpha-2, beta, gamma globulins) to detect abnormal patterns, while CPT 86320 (immunoelectrophoresis) is a more specific test that identifies individual immunoglobulins (IgG, IgA, IgM) and detects monoclonal proteins. Code 86320 is typically ordered as a reflex test when 84165 shows abnormalities requiring further characterization.

Can CPT 86320 and 86334 be billed together on the same date?

Generally, no. CPT 86334 (immunofixation electrophoresis) and 86320 (immunoelectrophoresis) serve similar diagnostic purposes and are considered alternative methods for immunoglobulin characterization. Most payers will deny one as duplicate or inclusive when billed together. Immunofixation (86334/86335) has largely replaced traditional immunoelectrophoresis (86320) in modern laboratories due to superior sensitivity and specificity.

What diagnosis codes support medical necessity for CPT 86320?

Common supporting diagnoses include: C90.00 (multiple myeloma), D89.1 (cryoglobulinemia), R77.1 (abnormal plasma protein levels), R79.1 (abnormal immunological findings), D80-D84 series (immunodeficiency disorders), and C88.x (malignant immunoproliferative diseases). Generic screening codes or routine physical exam codes typically do not support medical necessity and will result in denials.

How often will Medicare cover CPT 86320 for monitoring known conditions?

Medicare does not publish specific frequency limitations for CPT 86320 in national coverage determinations, but medical necessity must be demonstrated for each test. For monitoring multiple myeloma or other plasma cell disorders, testing frequency depends on clinical factors such as disease stability, treatment changes, and symptoms. Many Medicare Administrative Contractors (MACs) expect quarterly to semi-annual intervals for stable disease monitoring, with more frequent testing justified by clinical changes.

What CLIA certification level is required to perform CPT 86320?

CPT 86320 requires CLIA certification for high-complexity testing. Laboratories must have a CLIA certificate of compliance or certificate of accreditation, employ personnel meeting high-complexity testing qualifications, maintain appropriate quality control and proficiency testing programs, and operate under a qualified laboratory director. Moderate or waived CLIA certificates are insufficient for performing this test.

Is prior authorization required for CPT 86320?

Prior authorization requirements vary by payer and are uncommon for CPT 86320 due to its relatively low cost ($17.14 Medicare rate). However, some Medicare Advantage plans and commercial payers may require authorization for laboratory services. Always verify individual payer policies before performing the test. Medical necessity documentation should be available regardless of authorization requirements to support claims if questioned.