CPT Code 86038Complete Billing & Coding Guide (2026)Antinuclear antibodies
About CPT 86038
CPT 86038 is a Current Procedural Terminology code in the Pathology/Lab category maintained by the American Medical Association. The CMS short descriptor reads "Antinuclear antibodies". For the full AMA long descriptor and clinical guidance, refer to the current CPT code manual.
Documentation specificity, correct ICD-10 linkage, and modifier accuracy determine whether 86038 pays cleanly or triggers a denial. Verify CMS National Physician Fee Schedule status, applicable Medicare LCDs, and any payer-specific medical policies before submission.
86038 has 5 NCCI bundling edit pairs documented. Run your scrubber against the NCCI quarterly update before submission. When clinically warranted, use modifier 59 or the X-modifiers (XE, XS, XP, XU) to bypass an indicator-1 edit, with chart documentation supporting the distinct service.
Code Properties
RVU Breakdown
Every CPT code’s Medicare payment is calculated from three Relative Value Unit components: physician work, practice expense, and malpractice. Together they multiply by the conversion factor to produce the payment amount.
Payment = Total RVU × Conversion Factor ($33.4009) × Geographic Adjustment (GPCI). National averages shown. Actual payment varies by locality.
NCCI Bundling Edits
5 pairsThese codes trigger National Correct Coding Initiative edits when billed with 86038. An indicator of 0 means the pair cannot be unbundled. Indicator 1 means modifier 59 or X-modifiers may allow separate billing with supporting documentation.
Billing 86038 alongside a bundled code without the correct modifier generates CARC 97 denials. Payers often flag these as audit risks. Document medical necessity for the separate service and apply modifier 59 or the appropriate X-modifier (XE, XS, XP, XU) only when clinically justified.
Standards of medical/surgical practice
Standards of medical/surgical practice
Standards of medical/surgical practice
Standards of medical/surgical practice
CPT Manual or CMS manual coding instruction
Bundling denials on 86038 are recoverable when the edit indicator is 1 and the chart documents a distinct, separately identifiable service. Our coders verify the indicator and pick the precise X-modifier (XE, XS, XP, XU) instead of defaulting to modifier 59.
Applicable Modifiers
Modifiers commonly paired with 86038 based on its category. Apply only when the clinical circumstance warrants. Incorrect modifier use is a top audit target.
Component split modifiers (26 professional, TC technical) are the most under-applied modifiers in diagnostic billing. Practices that bill global on services where they only provided the read silently invite refund requests. We split components correctly at submission.
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Everything about CPT 86038
What does CPT code 86038 cover?
CPT 86038 is a Current Procedural Terminology code in the Pathology/Lab category maintained by the American Medical Association. The CMS short descriptor reads "Antinuclear antibodies". For the full AMA long descriptor and clinical guidance, refer to the current CPT code manual.
What is the Medicare payment for CPT 86038?
The national average Medicare payment for CPT 86038 is approximately $0 in a non-facility setting and $0 in a facility setting. Actual payment varies by locality based on GPCI adjustments. Total RVU is 0 with a conversion factor of $33.4009.
What is the global period for CPT 86038?
CPT 86038 has no global period (indicator XXX). There are no post-operative day restrictions tied to this code. Refer to CMS National Physician Fee Schedule rules and any applicable NCCI edits when billing on the same date as other services.
What codes bundle with CPT 86038?
CPT 86038 has NCCI Procedure-to-Procedure edits with 5+ codes including 80503, 80504, 80505. Modifier indicator 0 means the edit cannot be bypassed. Indicator 1 means modifier 59 or X-modifiers may allow separate billing with documentation.
CPT codes and descriptions are copyright of the American Medical Association. RVU values reflect current CMS publications. Actual payment varies by locality. Commercial payer rates vary by contract.
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We audit your last 90 days of claims and surface the revenue leakage: wrong modifiers, missed bundling appeals, ICD-10 specificity gaps. AAPC-certified coders. 2.49% of collections. No setup fees.