Multi-analyte blood test for rheumatoid arthritis that measures twelve serum biomarkers and combines them into a single disease activity score.
- Medicare
- $0.00
- Work RVU
- 0
- Global, days
- Region
- General
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Established rheumatoid arthritis diagnosis
- Current RA therapy
- Treatment decision the result will inform
- Date of last test, if any
- Ordering provider's clinical assessment of disease activity
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
This algorithmic test turns twelve blood biomarkers into a rheumatoid arthritis disease activity score. It is a single-lab proprietary test, and it is used by rheumatology to track RA activity alongside the exam and standard markers like CRP.
Orthopedic practices rarely order it. Where it intersects with ortho is the RA patient being evaluated for joint replacement or hand reconstruction, whose rheumatologist may have recent scores in the chart. That history is useful context, but it does not mean the ortho practice should order the test. Ordering it from an orthopedic clinic without a rheumatology treatment decision behind it invites a denial.
Coverage varies. Some payers cover it with specific criteria, many commercial plans treat it as investigational, and frequency is limited where it is covered. The lab bills it under the Clinical Laboratory Fee Schedule. The ordering note needs an established RA diagnosis and a treatment decision the result will inform.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 0 |
| Practice expense RVU | 0 |
| Malpractice RVU | 0 |
| Total RVU | 0 |
| Medicare national rate | $0.00 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $0.00 |
Common denial reasons
The recurring reasons claims for CPT 81490 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Payer considers the test investigational
- Ordered for diagnosis rather than monitoring of established RA
- Repeated more often than the payer allows
- No treatment decision documented
- Ordered by a non-treating specialty without rationale
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01What test does CPT 81490 describe?
02Is 81490 covered by insurance?
03Can 81490 be used to diagnose rheumatoid arthritis?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe captures the RA history, current therapy, and the rheumatologist's involvement in the note, giving useful context when planning surgery.
See how Mira captures CPT 81490 documentation