Antibody detection for extractable nuclear antigens in serum

Description

This laboratory test evaluates a patient's serum for antibodies against extractable nuclear antigens (ENA), which include specific antibodies associated with autoimmune diseases. Identifying these antibodies aids in the diagnosis of conditions such as systemic lupus erythematosus and Sjögren's syndrome.

Medicare Hospital Outpatient Reimbursement (OPPS)

OPPS Payment Rate

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Patient Copayment / Coinsurance

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Top Modifiers

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HCPCS/CPT 59Distinct procedural service for non-E/M services(20.45%)

HCPCS/CPT 90Reference laboratory services performed by an outside laboratory(17.84%)

HCPCS/CPT 91Repeat clinical diagnostic laboratory test performed on the same day(15.77%)

HCPCS/CPT XUUnusual non-overlapping service(4.77%)

HCPCS/CPT GWService unrelated to hospice patient's terminal condition(3.6%)

HCPCS/CPT GAWaiver of liability statement issued per payer policy(1.98%)

HCPCS/CPT 77Repeat procedure by another qualified healthcare professional(1.44%)

HCPCS/CPT GZItem or service expected to be denied as not reasonable and necessary(1.35%)

HCPCS/CPT Q4Service exemption for laboratory services by ordering/referring physician(1.26%)

HCPCS/CPT 76Repeat procedure or service by same physician or qualified healthcare professional(1.17%)

Code Crosswalks

No crosswalks found.

Alternate Codes

No alternates found.

Billed With Codes

No codes found here.

Sources

We make no claims to ownership of the coding systems referenced on this platform. Codes and descriptions are produced from claims and chargemaster data available through the CMS-9915-F Transparency in Coverage Final Rule and via state or federal datasets. This service is provided solely as a reference to encourage use of these codes in our chargemaster review and automated billing tools, so that healthcare professionals can understand and correctly report these codes in their claims.

Federal and State Datasets

List of CPT/HCPCS Codes, Centers for Medicare & Medicaid Services (CMS)
I/OCE Quarterly Release Files, Centers for Medicare & Medicaid Services (CMS)
Physician Fee Schedule Relative Value Files, Centers for Medicare & Medicaid Services (CMS)
OPPS Addendum B, Centers for Medicare & Medicaid Services (CMS)
ASC Payment Addenda, Centers for Medicare & Medicaid Services (CMS)