Screening test that uses fluorescent-labeled antibodies to detect a specific antibody in serum, reported once per antibody screened.
- 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 2 cited references ↓
- Antibody being screened, named on the order
- Clinical reason, such as suspected vasculitis
- Lab report showing fluorescent method and result
- Unit count matching antibodies screened
- Confirmation no specific antibody code applies
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 ↓
86255 is a method code. It reports a fluorescent antibody screen, one unit per antibody, when no more specific code describes the antibody being tested. Labs commonly use it for indirect immunofluorescence tests such as ANCA screening in a vasculitis workup.
It rarely comes from an orthopedic order directly. It shows up when a patient with joint pain, nodules, or unusual inflammatory findings is worked up for vasculitis, or as part of a broader autoimmune panel a rheumatologist builds. Orthopedic practices that bill labs on a purchased basis should match the lab's coding rather than guess.
The common errors are using 86255 when an antibody has its own CPT code, and billing it alongside a titer code without both results on the report. If the lab follows a positive screen with a titer, the titer has its own code (86256). Each needs a result on the report to be billable.
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 86255 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Specific antibody code exists
- Titer billed without positive screen
- Units exceed antibodies documented
- Diagnosis does not support autoimmune testing
- Duplicate claim with reference lab
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 2 cited references ↓
01What tests use 86255?
02What is the titer code that goes with 86255?
03Can an orthopedic office bill 86255?
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 systemic findings that lead to a vasculitis or autoimmune workup, so the antibody screen has a clear clinical reason behind it.
See how Mira captures CPT 86255 documentation