CPT code 86485, 86480, 86490, 86580 - Tb test

CPT CODE AND Description

86485 - Skin test; candida
86490 - Skin test; coccidioidomycosis - Average Fee amount $65 - $90
86580 - Skin test; tuberculosis, intradermal - Average Fee amount $7 - $10

ALL CPT required CLIA. Recently Medicare Excluded these CPTs from CLIA Edits

TB Testing – CPT 86580 / ICD9 V74.1

• Since the test is an inoculation screening test, rather than a vaccination, the test includes administering the skin test and you should not code separately for the administration.

• The Resource Based Relative Value System (RBRVS) does not include costs for a reading.

• Patients who do not show a response to the test may never return for a reading so this nurse “reading” cost is not included in the RVUs for 86580.

• If the patient does return for a reading, you may code 99211 for the nurse reading. Make sure to document appropriately

Early, Periodic, Screening, Diagnostic and Treatment (EPSDT) Bundling Update

UnitedHealthcare Community Plan has received additional clarification from Arizona Health Care Cost Containment System (AHCCCS) regarding Tuberculosis Testing services (86580) included in the EPSDT visit. The AHCCCS Medical Policy Manual, Chapter 400, Policy 430, contains language specifically related to lab testing:

Payment for laboratory services that are not separately billable and considered part of the payment made for the EPSDT visit include, but are not limited to: 99000, 36415, 36416, 36400, 36406, and 36410. In addition, payment for all laboratory services must be in accordance with limitations or exclusions specified in AHCCCS health plan contract with the providers1.

Since CPT 86580 falls under Pathology/Laboratory services and is not included in those codes listed above, services using CPT 86580 during the EPSDT visit should be billed and processed separately according to the AHCCCS provider contract.

UnitedHealthcare Community Plan will reflect these changes by March 24, 2015. Any claims previously denied or recovered prior to this correction being implemented will be adjusted to process appropriately according to this new guidance.


1. Currently, CPT Code 86485* - Skin test; Candida – is the code available for the cost of the CANDIN and materials used in the skin test. This code does not include possibly related procedures such as office visits, injection, reading, or patient consultation.

3. Submit reasonable and necessary charges in accordance with, along with the current CPT Code. (current CANDIN estimated price per test is $14.90**).

4. The insurance company may ask for a copy of the invoice for the purchase of CANDIN in order to confirm the price.

Laboratory and Venipuncture Services Bundled Example: If procedure code 80047 (PCTC IND of 9 ) or  86485 (PCTC IND of 3) is reported with a facility place of service, the line item will deny.

Do you know how to code for a PPD/TB Skin Test? Proper coding for this test is quite simple. CPT 86580 is described as Skin Test; tuberculosis, intradermal and includes the administration of the test; therefore, do not attempt to bill any type of administration code in conjunction with CPT 86580. The appropriate diagnosis code for CPT 86580 is V74.1.

Generally, the nurse will administer the skin test and instruct the patient to return to the clinic for a reading a few days later. A nurse visit, CPT 99211 may be reported for the reading. The nurse must remember to document a proper nurse visit note (this is an E&M service)

• To be able to separate purchased vs. state supplied TST use the LU114 code for state supplied TST (report only) and the CPT code 86580 for purchased TST which can have a charge attached.

• If the client has private insurance only and a RN is the provider, you can use the 99211 E&M code. Other providers eligible to bill private insurance would use the appropriate E&M code for the level of service provided.

• When a client receives TB services (must be for a billable TB service) billed with an E&M code and is also seen by another health department provider on the same date of service for a separately identifiable medical condition, the health department may bill the appropriate E&M code, provided the diagnosis on the claim form indicates the separately identifiable medical condition and modifier 25 is  deppended to the E & M code for the second visit.

TB treatment services

Performed by professional providers – office visits only The E/M codes 99201-99215 are for office visits only, and must be billed for professional providers such as physicians (or nursing staff under a physician’s supervision), Advanced Registered Nurse Practitioners (ARNPs), and Physician Assistants (PAs). Performed by professional providers – in client’s home, see home services.

Performed by nonprofessional providers – office visits and in client’s home Health departments billing for TB treatment services provided by nonprofessional providers in either the client’s home or in the office must bill using HCPCS code T1020 (personal care services). Do not bill the initial visit with a modifier. Follow-up visits must be billed using T1020 with modifier TS (follow-up services modifier). Use the appropriate ICD diagnosis code. See the agency’s Approved Diagnosis Codes by Program web page for Physician-Related Services/Health Care Professionals.

TB treatment services – performed by professional providers – in client’s home When billing for TB treatment services provided by professional providers in the client’s home, Health Departments may also bill CPT codes 99341 and 99347.

For TB treatment services performed by nonprofessional providers in client’s home, see TB treatment services for nonprofessional providers – office or client’s home

Targeted TB testing with interferon-gamma release assays

Targeted TB testing with interferon-gamma release assays may be considered medically necessary for clients age five and older for one of the following conditions:

• History of positive tuberculin skin test or previous treatment for TB disease
• History of vaccination with BCG (Bacille Calmette-Guerin)
• Recent immigrants (within 5 years) from countries that have a high prevalence of tuberculosis
• Residents and employees of high-risk congregate settings (homeless shelters, correctional facilities, substance abuse treatment facilities)
• Clients with an abnormal chest X-ray (CXR) consistent with old or active TB
• Clients undergoing evaluation or receiving TNF alpha antagonist treatment for rheumatoid arthritis, psoriatic arthritis, or inflammatory bowel disease
• Exposure less than two years before the evaluation


• Client agrees to remain compliant with treatment for latent tuberculosis infection if found to have a positive test

The tuberculin skin test is the preferred method of testing for children under the age of 5.

CPT Code Short Description 86480 Tb test cell immun measure 86481 Tb ag response t-cell susp Providers must follow the agency’s expedited prior authorization (EPA) process to receive payment for targeted TB testing. See EPA #870001325 in EPA Criteria Coding List.

Procedure Code Short Description

85032 Manual cell count each
85046 Reticyte/hgb concentrate
85049 Automated platelet count
85378 Fibrin degrade semiquant
85380 Fibrin degradj d-dimer
85384 Fibrinogen activity
85396 Clotting assay whole blood
85610 Prothrombin time
85730 Thromboplastin time partial
86308 Heterophile antibody screen
86367 Stem cells total count
86403 Particle agglut antbdy scrn
86880 Coombs test
86900 Blood typing ABO
86901 Blood typing rh (d)
86920 Compatibility test spin
86921 Compatibility test incubate
86922 Compatibility test antiglob
86923 Compatibility test electric
86971 Rbc pretx incubatj w/enzymes
87205 Smear gram stain
87210 Smear wet mount saline/ink
87281 Pneumocystis carinii ag if
87327 Cryptococcus neoform ag eia
87400 Influenza a/b ag eia
89051 Body fluid cell count
86367 Stem cells total count
86923 Compatibility test electric
88720 Bilirubin total transcut
88740 Transcutaneous carboxyhb
88741 Transcutaneous methb


Medicaid covers tuberculosis (TB) testing according to the AAP periodicity schedule, and upon the recognition of high risk factors. Coverage for the TB test includes any return visit to read the results of the TB test. A risk assessment must be completed at each well child visit. Mantoux testing is the preferred testing method. For assistance in determining high risk and testing, providers may refer to the AAP Red Book: Report of the Committee on Infectious Diseases, or contact the MDHHS Division of Communicable Diseases and/or the Division of Immunization.

1 comment:

Robin Jack said...

I was surfing net and luckily ran over this site and discovered exceptionally intriguing stuff here. Its truly amusing to peruse. I delighted in a considerable measure. A debt of gratitude is in order for sharing this magnificent data. camping generators

Top Medicare billing tips