Screening test for antistreptolysin O antibodies, showing whether a patient had a recent group A streptococcal infection.
- Medicare
- $0.00
- Work RVU
- 0
- Global, days
- Region
- Multi-region
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 2 cited references ↓
- Recent sore throat, strep test, or skin infection history
- Joint findings, including migration between joints
- Diagnosis of arthritis or arthralgia with suspected post-strep cause
- Order specifying ASO screen versus titer
- Lab report with qualitative result
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 2 cited references ↓
The antistreptolysin O screen (86063) answers one question: did this patient recently have a strep infection. In orthopedics that matters for a child or young adult with migratory joint pain or swelling after a sore throat. Post-streptococcal reactive arthritis and acute rheumatic fever both present to the ortho clinic first, often as a limp or a swollen knee or ankle.
The screen is qualitative. If the lab measures a titer, that is a different code (86060). Bill the one matching the result. ASO is often ordered with anti-DNase B (86215), because some patients only raise one of the two. Both can be billed when both were run.
The diagnosis should describe the joint findings and the recent infection history. Arthralgia with a documented sore throat or positive throat culture holds up. ASO attached to a sports injury does not.
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 86063 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Titer result billed as 86063
- No infection history documented
- Diagnosis limited to injury
- Repeat testing too soon to show change
- Duplicate billing with reference lab
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 2 cited references ↓
01What is the difference between 86060 and 86063?
02Can I bill ASO and anti-DNase B together?
03Why would an orthopedist order an ASO?
Sources & references
Editorial content was developed using the following public sources.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/medicare/payment/fee-schedules/clinical-laboratory-fee-schedule-clfs
Mira Scribe
Mira Scribe captures the recent illness history families mention in passing, like a sore throat two weeks ago, which supports a post-strep workup.
See how Mira captures CPT 86063 documentation