Code Information
CPT® Code Set - 86431
Code Information
86431 - CPT® Code
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Code History
Anatomy & Physiology Online for Coders
Access to great code-based anatomy information is available with the Anatomy & Physiology Online for Coders add-on.
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Click on a link to view the following terms in Anatomy & Physiology Online for Coders.
Rheumatoid arthritis (Clinical text)
Clinical
Rheumatoid arthritis (Clinical slide)Rheumatoid arthritis (Clinical text)
Connective Tissue
BloodCopyright © 2013 Primal Pictures., Inc. All Rights Reserved.
My Notes
Articles & Newsletters
CPT® Assistant Articles
CPT® Assistant is the official newsletter on CPT coding, published by the AMA. The CPT Assistant Archives are available to subscribers as an add-on.
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No CPT® Assistant Articles link directly to this code.
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DecisionHealth® Articles
Viewing DecisionHealth® articles requires the DecisionHealth® Newsletters product.
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No DecisionHealth® Articles link directly to this code.
AHA Coding Clinic® Articles
AHA Coding Clinic® for HCPCS
No AHA Coding Clinic® for HCPCS Articles link directly to this code.
Coding Tips
Fees
SCH (Sole Community Hospital)‡:
Lab Fees
| Modifier | National Minimum | National Maximum (NLA) | Carrier Limit | My Fee | Estimated Payment† | |
|---|---|---|---|---|---|---|
| Facility | (none) | $0.00 | $7.80 | $8.05 | (your fee) | $7.80 |
| Facility | (none) | $0.00 | $8.06 | $8.32 | (your fee) | $8.06 |
| Non-Facility | (none) | $0.00 | $7.80 | $8.05 | (your fee) | $7.80 |
| Non-Facility | (none) | $0.00 | $8.06 | $8.32 | (your fee) | $8.06 |
† Estimated Payment is the lesser of: Carrier Limit, National Maximum, and Provider Fee ("My Fee"), but not less than the National Minimum.
‡ Qualified labs of Sole Community Hospitals receive a 62% update, rather than 60% (higher payment).
N/E = No fee has been established for this code/modifier combination by CMS.
N/A = You must select a carrier to show carrier-specific data. Sign In or Subscribe to continue.
‡ Qualified labs of Sole Community Hospitals receive a 62% update, rather than 60% (higher payment).
N/E = No fee has been established for this code/modifier combination by CMS.
N/A = You must select a carrier to show carrier-specific data. Sign In or Subscribe to continue.
APC Fee Information
Note: APC information, including Status Indicator, Relative Weight, Payment Rate, Crosswalks, and more, is available to Subscribers with the Hospital/Facility product.
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Cross-A-Code™ (ICD-9, CPT, HCPCS, Modifiers, ASA CROSSWALK®)
NCCI Edits
Medicare Policies & Guidelines
Subscribers may see Crosswalks here for Local Coverage Determinations (LCDs) or Ambulatory Patient Classifications (APCs) with information on covered diagnosis and procedure codes.
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Physician Quality Reporting System (PQRS)
PQRS is a program where an incentive payment is made to professionals who report data on various measures.
Learn more about PQRS or Read about PQRS at cms.gov.
This code (86431) is not used with any individual PQRS measures.