CPT 86580Laboratory

Tb intradermal test

CPT code 86580 covers the tuberculosis (TB) skin test, commonly known as a PPD or Mantoux test, where a small amount of tuberculin is injected under the skin to check for TB exposure or infection.

Showing rates for

National Average

Base Medicare rate

$9.70

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

PE RVU (NF)

0.29

MP RVU

0.01

Total RVU

0.3

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

NCCI bundling edits

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Billing tips

Bill both administration (86580) and reading (often 86580 again or evaluation code) as separate encounters 48-72 hours apart to capture full reimbursement
Impact: Failing to bill the reading visit results in 50% revenue loss; each component reimburses at $9.70 for total $19.40 per complete test
Verify payer-specific policies as some commercial payers require CPT 86580 for both administration and reading, while others accept only administration with reading captured via E/M
Impact: Incorrect code selection results in denials or downcoding; can affect 30-40% of commercial claims if policy not followed
Document exact time of administration and scheduled reading appointment in medical record to support medical necessity for two-visit protocol
Impact: Prevents denials for medically unnecessary return visits; supports the 48-72 hour reading window requirement
Report the specific tuberculin product administered (PPD, Tubersol, Aplisol) and lot number in documentation to meet vaccine/biologics tracking requirements
Impact: Essential for compliance with vaccine tracking regulations; prevents audit findings and potential quality measure penalties
Do not bill 86580 with blood-based TB tests (86480, 86481); these are mutually exclusive services for the same indication
Impact: Bundling violations result in denial of one or both codes; proper selection based on method prevents claim rejection
For Medicare patients, verify LCD (Local Coverage Determination) requirements as frequency limitations typically restrict screening to high-risk populations only
Annual routine screening for low-risk patients will be denied; medical necessity documentation prevents estimated 20-30% denial rate

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 86580 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 86580 is $9.70 for both facility and non-facility settings, based on 0.3 total RVUs and the 2025 conversion factor of 32.3465.

Can you bill CPT 86580 twice for the same patient - once for administration and once for reading?

This depends on payer policy. Many payers allow 86580 to be billed for administration and again for the reading visit 48-72 hours later, effectively allowing two units. However, some payers require the reading to be captured via an E/M code instead. Always verify specific payer guidelines before billing.

What diagnosis codes support medical necessity for CPT 86580?

Common supporting ICD-10 codes include Z11.1 (encounter for screening for TB), Z20.1 (contact with and exposure to TB), Z56.89 (occupational exposure requiring health screening), and various immunocompromised conditions. Medicare typically requires high-risk factors documented for coverage.

Is CPT 86580 covered for routine employment screening by Medicare?

Generally no. Medicare rarely covers routine employment or pre-procedural TB screening for low-risk beneficiaries. Coverage typically requires documented TB exposure, symptoms, high-risk living conditions, or immunosuppression. Commercial payers and workers' compensation typically cover occupational screening.

What is the difference between CPT 86580 and the QuantiFERON blood test codes?

CPT 86580 is for the intradermal tuberculin skin test (TST/PPD), while CPT 86480-86481 represent blood-based interferon-gamma release assays (IGRAs) like QuantiFERON. These are alternative methods for TB testing; only one method should be billed per testing episode unless specific clinical circumstances justify both.

Do you need modifier 25 when billing 86580 with an E/M service?

Yes, if the E/M service represents a separately identifiable evaluation beyond the decision to perform and administration of the TB test. Modifier 25 should be appended to the E/M code (not 86580) to indicate the significant, separately identifiable service. Documentation must support the separate service.

How often can CPT 86580 be billed for the same patient?

Frequency limits vary by payer. Medicare typically restricts coverage to high-risk individuals and may question repeat testing within 12 months without documented exposure or clinical indication. Occupational medicine and some commercial plans may cover annual or biannual testing based on employment requirements. Always document medical necessity for repeat testing.