CPT® Code 86431 is used to report quantitative measurement of rheumatoid factor (RF) in blood, an important laboratory marker for autoimmune and inflammatory conditions, particularly rheumatoid arthritis. RF testing helps providers diagnose, monitor, and manage autoimmune disease activity.
This code represents the laboratory test itself, not specimen collection, interpretation, or evaluation and management services, which may be reported separately when appropriate.
Key Facts About CPT® 86431
- Service type: Laboratory blood test
- Provider type: Physicians, laboratories, and qualified healthcare professionals
- Medical services included: Yes—quantitative RF measurement
- Specimen type: Serum or plasma
- Test purpose: Autoimmune and inflammatory disorder evaluation
- Common clinical indications:
- Diagnosis of rheumatoid arthritis
- Monitoring disease activity in autoimmune disorders
- Differentiation of inflammatory joint disease from other conditions
- Assessment of chronic systemic inflammation
When to Use CPT® 86431
CPT 86431 is appropriate when:
- Quantitative RF testing is ordered to support the diagnosis of autoimmune disease
- Monitoring progression or treatment response in rheumatoid arthritis
- Evaluating patients with joint pain, swelling, or chronic inflammation
- Differentiating inflammatory versus non-inflammatory arthropathies
Examples:
- Measuring RF levels in a patient with symmetric joint swelling
- Monitoring response to disease-modifying antirheumatic drugs (DMARDs)
- Evaluating suspected autoimmune disease flare
Documentation Requirements
To support CPT 86431 billing, documentation should include:
- Patient identifiers and date of service
- Clinical indication for RF testing
- Specimen source
- Test performed (quantitative rheumatoid factor)
- Test result and date reported
- Ordering provider information
Thorough documentation ensures compliance, appropriate reimbursement, and continuity of care.
Reimbursement and Coding Considerations
- CPT 86431 is generally covered when medically necessary
- Diagnosis coding should support autoimmune or inflammatory indications
- Specimen collection may be billed separately if allowed by payer
- Often performed alongside other rheumatology tests (e.g., ESR, CRP, ANA)
- Frequency limitations may apply depending on payer policy
Always verify payer-specific laboratory billing requirements prior to submission.
How OptiMantra Supports Rheumatoid Factor Testing
OptiMantra’s integrated EMR and practice management system streamlines documentation and billing for CPT 86431:
With OptiMantra, providers can:
- Order and document RF tests within the patient chart
- Track RF levels longitudinally to monitor disease activity
- Link results to diagnoses, treatment plans, and follow-up recommendations
- Support compliant, audit-ready laboratory billing documentation
- Maintain complete longitudinal lab records for autoimmune disease management
By centralizing lab workflows, OptiMantra helps practices improve efficiency, ensure compliance, and optimize reimbursement for rheumatology testing.
Try OptiMantra for free here!
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