Test for antibodies to an extractable nuclear antigen such as SSA, SSB, Smith, RNP, Scl-70, or Jo-1, reported once per antibody.
- 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 3 cited references ↓
- Positive ANA or clinical findings suggesting connective tissue disease
- List of each antibody tested
- Unit count matching the antibody list
- Diagnosis consistent with suspected connective tissue disease
- Lab report with individual results
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 ↓
Extractable nuclear antigen antibodies are billed with 86235, one unit per antibody. They follow a positive ANA and help name the disease: SSA and SSB for Sjogren syndrome, Smith for lupus, RNP for mixed connective tissue disease, Scl-70 for scleroderma, Jo-1 for myositis.
Orthopedic practices rarely order the full ENA panel themselves. Hand surgeons see it more, since Raynaud phenomenon, sclerodactyly, or digital ulcers bring scleroderma patients to their clinic. More often, an ortho practice sees 86235 on a reflex panel triggered by a positive ANA ordered during an inflammatory arthritis workup.
Units are the main billing issue. A six-antibody ENA panel is six units of 86235. Payers have per-day unit limits, and claims that exceed them deny the whole line or the excess. List each antibody tested. Repeat ENA testing after a diagnosis is established is rarely covered.
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 86235 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Units exceed payer limit per date
- No positive ANA or supporting findings
- Repeat testing after established diagnosis
- Antibodies with their own codes, such as dsDNA, billed as 86235
- Duplicate billing with reference lab
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01How many units of 86235 for an ENA panel?
02Is anti-dsDNA billed with 86235?
03Do I need a positive ANA before billing 86235?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe records findings like Raynaud symptoms, skin changes, and dry eyes alongside the joint exam, which supports a full autoimmune panel.
See how Mira captures CPT 86235 documentation