CPT 86334Laboratory

Immunofix e-phoresis serum

CPT code 86334 covers immunofixation electrophoresis performed on a blood serum sample, a laboratory test used to identify abnormal proteins in the blood that may indicate conditions like multiple myeloma or other blood disorders.

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

Always bill 86334 based on documented medical necessity with supporting ICD-10 codes such as D47.2 (MGUS), C90.00 (multiple myeloma), or R77.1 (abnormal plasma proteins)
Impact: Proper diagnosis coding prevents 60-70% of medical necessity denials and ensures LCD compliance
Do not bill 86334 as a screening test; it should follow an abnormal SPEP (84165) or clinical indication of monoclonal gammopathy
Impact: Billing without documented indication results in immediate denial; appeals rarely successful without clear medical necessity
Verify Local Coverage Determination (LCD) requirements for frequency limitations; many Medicare contractors limit to 1-2 tests per year for monitoring stable conditions
Impact: Exceeding frequency limits without ABN results in write-off of the $17.14 reimbursement plus processing costs
When billing for both serum (86334) and urine (86335) immunofixation on the same date, ensure separate medical necessity is documented for each specimen type
Impact: Combined testing when medically appropriate increases total reimbursement to approximately $34.28 but requires clear documentation
Obtain an Advance Beneficiary Notice (ABN) when frequency limits may be exceeded or medical necessity is questionable
Impact: ABN allows patient billing if Medicare denies; protects laboratory from $17.14 loss per denied claim
Bill on the date the test was performed, not the date results were reported, to ensure accurate claim adjudication
Impact: Incorrect dating can trigger duplicate claim denials or coordination of benefits issues

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 86334 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 86334 is $17.14 for both facility and non-facility settings, based on 0.53 total RVUs and a conversion factor of 32.3465.

What is the difference between CPT 86334 and 84165?

CPT 84165 is serum protein electrophoresis (SPEP), a screening test that separates proteins into general bands, while CPT 86334 is immunofixation electrophoresis (IFE), a more specific confirmatory test that identifies and characterizes monoclonal proteins detected on SPEP. IFE is typically ordered after an abnormal SPEP result.

How often can CPT 86334 be billed for Medicare patients?

Frequency limitations vary by Medicare contractor LCD, but most allow 1-2 tests annually for stable monitoring of known monoclonal gammopathies. More frequent testing may be covered for active disease management, newly diagnosed conditions, or therapeutic monitoring with appropriate documentation.

What diagnosis codes support medical necessity for CPT 86334?

Common supporting diagnosis codes include C90.00 (multiple myeloma), D47.2 (monoclonal gammopathy of undetermined significance), C88.0 (Waldenstrom macroglobulinemia), E85.9 (amyloidosis), R77.1 (abnormality of globulin), and R77.2 (abnormality of albumin). The ordering diagnosis must reflect a clinical indication for protein analysis.

Can CPT 86334 and 86335 be billed together?

Yes, CPT 86334 (serum immunofixation) and 86335 (urine immunofixation) can be billed together when both specimen types are medically necessary. This is common in evaluating for light chain disease, amyloidosis, or comprehensive assessment of monoclonal gammopathies, but separate medical necessity for each specimen must be documented.

Is CPT 86334 a CLIA-waived test?

No, CPT 86334 is classified as a high-complexity test under CLIA regulations. It must be performed in a laboratory certified for high-complexity testing with qualified personnel and appropriate quality control measures. Modifier QW should not be used with this code.

What are the Work RVUs for CPT 86334 in 2025?

For 2025, CPT 86334 has 0.37 Work RVUs, 0.15 Practice Expense RVUs (both facility and non-facility), and 0.01 Malpractice RVUs, totaling 0.53 RVUs. These values are from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.