CPT 86325Laboratory

Other immunoelectrophoresis

CPT 86325 covers specialized laboratory testing that identifies and analyzes specific proteins in blood using an electrical field technique called immunoelectrophoresis. This test helps diagnose immune disorders, protein abnormalities, and certain blood-related diseases.

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

Loading bundling edits…

Billing tips

Verify that the immunoelectrophoresis method performed does not fall under more specific CPT codes (86320, 86327) before defaulting to 86325
Impact: Prevents upcoding or downcoding denials; ensures accurate $17.14 payment rather than potential recoupment or incorrect reimbursement from wrong code selection
Document the specific antiserum or antibody used and the clinical indication requiring immunoelectrophoresis beyond standard protein electrophoresis
Impact: Reduces medical necessity denials by 40-60%; documentation supporting why routine tests are insufficient justifies the $17.14 reimbursement
Bill only once per specimen regardless of number of antisera tested, unless distinctly different methodologies are employed
Impact: Prevents duplicate billing denials; units should be 1 unless multiple distinct specimens analyzed; incorrect units billing can trigger audit flags
Link appropriate ICD-10 codes for plasma cell disorders (C90.x), immunodeficiency (D80-D84), or abnormal protein findings (R77.x) to establish medical necessity
Impact: Increases first-pass claim acceptance rate by 35%; strong diagnosis linkage prevents LCD-based denials and supports $17.14 payment
For Medicare claims, ensure ordering physician NPI is included and that test is ordered for a covered indication per LCD guidelines
Impact: Missing ordering physician information results in automatic denial; proper documentation ensures timely $17.14 payment without delays
When billing commercial payers, verify whether prior authorization is required for specialized immunology testing before specimen collection

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 86325?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the Medicare reimbursement rate for CPT 86325 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 86325 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 reimbursement may vary by locality based on geographic practice cost indices (GPCI).

What is the difference between CPT 86325 and other immunoelectrophoresis codes?

CPT 86325 is used for 'other' immunoelectrophoresis methods not specifically covered by CPT 86320 (immunoelectrophoresis, serum) or 86327 (immunoelectrophoresis, crossed). Use 86325 when the specific technique employed does not match the defined methodologies in other codes within the immunoelectrophoresis family.

How many RVUs is CPT code 86325 worth?

CPT 86325 has a total of 0.53 RVUs for 2025, consisting of 0.37 work RVUs, 0.15 practice expense RVUs (both facility and non-facility), and 0.01 malpractice RVUs. These values are published in the CMS Physician Fee Schedule RVU25A file released December 23, 2024.

Can CPT 86325 be billed with a modifier 91 for repeat testing?

Yes, modifier 91 can be appropriately appended to CPT 86325 when repeat immunoelectrophoresis testing is medically necessary on the same day. Documentation must clearly support why the repeat test was clinically required, such as confirmation of unexpected results, quality control issues with initial specimen, or clinical change requiring reassessment.

What diagnosis codes support medical necessity for CPT 86325?

Common supporting ICD-10 codes include multiple myeloma (C90.0x), other plasma cell disorders (C90.x), immunodeficiency disorders (D80-D84), abnormal immunoglobulins (D89.x), abnormal serum protein findings (R77.x), and hyperglobulinemia (R77.1). Always select the most specific diagnosis code that reflects the clinical indication for ordering the test.

Do I need prior authorization for CPT 86325?

Medicare typically does not require prior authorization for CPT 86325, but coverage is subject to Local Coverage Determination (LCD) medical necessity criteria. Many commercial insurance plans do require prior authorization for specialized immunology testing including immunoelectrophoresis. Always verify payer-specific requirements before performing the test to avoid denials.

What CLIA certification level is required to perform CPT 86325?

CPT 86325 requires high-complexity CLIA certification. Immunoelectrophoresis is classified as a high-complexity test under CLIA regulations and must be performed in a laboratory with appropriate certification and under the supervision of a qualified laboratory director. Waived or moderate-complexity CLIA certificates are insufficient for billing this code.