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A quantitative immunoassay for tumor antigen, coded as CPT® 86316, is a laboratory test that measures the levels of specific tumor antigens in the serum. Tumor antigens, also known as tumor markers, are substances produced by cancer cells or by the body in response to cancer. The presence of significant levels of these antigens can indicate the presence of malignancy. This particular code encompasses a range of tumor antigens that are not specified elsewhere in the coding system. Examples of tumor antigens associated with this code include CA 50, CA 72-4, and CA 549. Each of these antigens is linked to specific types of cancers; for instance, CA 50 is primarily associated with gastrointestinal cancers such as pancreatic, gastric, colorectal, and hepatic carcinomas. CA 72-4 is utilized in the detection of gastrointestinal and breast cancers, while CA 549 is specifically relevant for breast cancer patients. Various immunoassay techniques are employed to detect these tumor antigens, including the use of monoclonal antibodies and radioimmunoassay for CA 50, CA 72-4, and CA 549. Additionally, soluble mesothelin-related peptides, another tumor antigen tested under this code, are evaluated using enzyme-linked immunosorbent assay (ELISA) to assist in the management of mesothelioma. Other methods such as enzyme immunoassay and chemiluminescent immunoassay may also be utilized for different tumor antigens. Regular testing of tumor antigens is an important part of cancer management, as it helps in monitoring the progression or regression of the disease in conjunction with other clinical assessments.
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The quantitative immunoassay for tumor antigen, CPT® 86316, is indicated for the following conditions:
The procedure for conducting a quantitative immunoassay for tumor antigen involves several key steps:
Post-procedure care for patients undergoing a quantitative immunoassay for tumor antigen typically involves monitoring for any immediate reactions to the blood draw, although such reactions are rare. Patients may be advised to follow up with their healthcare provider to discuss the results of the test and any necessary next steps in their treatment or monitoring plan. Regular monitoring of tumor antigen levels is essential for evaluating the effectiveness of ongoing treatment and for making informed decisions regarding patient care.
| Short Descr | IMMUNOASSAY TUMOR OTHER | Medium Descr | IMMUNOASSAY TUMOR ANTIGEN QUANTITATIVE | Long Descr | Immunoassay for tumor antigen, other antigen, quantitative (eg, CA 50, 72-4, 549), each | Status Code | Statutory Exclusion (from MPFS, may be paid under other methodologies) | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | CLIA Waived (QW) | No | APC Status Indicator | Conditionally packaged laboratory tests | Type of Service (TOS) | 5 - Diagnostic Laboratory | Berenson-Eggers TOS (BETOS) | T1H - Lab tests - other (non-Medicare fee schedule) | MUE | 2 | CCS Clinical Classification | 235 - Other Laboratory |
| 90 | Reference (outside) laboratory: when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GZ | Item or service expected to be denied as not reasonable and necessary | GA | Waiver of liability statement issued as required by payer policy, individual case | 91 | Repeat clinical diagnostic laboratory test: in the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of modifier 91. note: this modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. this modifier may not be used when other code(s) describe a series of test results (eg, glucose tolerance tests, evocative/suppression testing). this modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient. | Q4 | Service for ordering/referring physician qualifies as a service exemption | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2011-01-01 | Changed | Short description changed. |
| 2005-01-01 | Changed | Code description changed. |
| 2001-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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