Antinuclear antibody test that reports whether ANA is present, used as a first-line screen for systemic autoimmune disease.
- Medicare
- $0.00
- Work RVU
- 0
- Global, days
- Region
- Multi-region
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Pattern of joint involvement and duration
- Morning stiffness, rash, or other systemic findings
- Diagnosis such as polyarthritis or arthralgia of multiple sites
- Order for ANA screen, with reflex if requested
- Lab report showing screen result
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 3 cited references ↓
Surgeons order an ANA screen (86038) when joint pain does not fit a mechanical pattern: several swollen joints, morning stiffness over an hour, a young patient with bilateral hand pain, or a rash with arthralgia. It sits alongside rheumatoid factor, CCP, ESR, and CRP in the standard inflammatory arthritis workup before referral to rheumatology.
If the screen is positive, labs often reflex to a titer (86039) and a pattern. Each is billed by the lab as performed. Do not bill the titer when only the screen was done, and do not bill both if the lab reported a single titer result without a separate screen. Multiplex bead ANA panels that report individual antibodies are coded per antibody under other codes.
Payers want symptoms consistent with autoimmune disease. A single sore knee with an ANA attached will often deny. Document joint count, stiffness, and any systemic signs.
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 86038 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Single-joint mechanical complaint as the only diagnosis
- Titer billed when only screen was done
- Screen and titer both billed for one result
- Multiplex panel billed as ANA screen
- Repeat ANA without a change in symptoms
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01What is the difference between 86038 and 86039?
02Can an orthopedic surgeon order an ANA?
03Why was my ANA claim denied for knee pain?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe records joint count, stiffness duration, and systemic symptoms, which are the details that make an autoimmune workup look necessary to a payer.
See how Mira captures CPT 86038 documentation