CPT® Code 86580

Last Updated: January 2026 | Verified for 2026 AMA CPT & CMS Guidelines

Quick Reference: CPT 86580

• Definition: Skin test; tuberculosis, intradermal — the Mantoux tuberculin skin test (TST), also known as the PPD (purified protein derivative) test.
• What’s Included: The CPT code bundles the PPD antigen material and the intradermal injection. Do not add a separate administration code (e.g., 96372 or 90471).
• Reading (Return Visit): The test reading 48–72 hours later is not included in 86580 per the AMA and AAP; a separate 99211 may be reported for the nurse or clinician reading.
• Primary ICD-10: Z11.1 (Encounter for screening for respiratory tuberculosis) for routine screening; R76.11 for a nonspecific reaction to tuberculin skin test without active TB.
• Medicare Coverage: Not a covered preventive service for most Medicare Part B beneficiaries unless medically necessary. An ABN is recommended when coverage is uncertain.
• Key Exclusion: Do not bill 90471 (vaccine administration) with 86580 — PPD is not a vaccine. CPT 86580 is the code used to report the tuberculin skin test (TST), one of the most widely performed diagnostic screening procedures in primary care, occupational health, public health, and pediatric settings. The test identifies immune sensitization to Mycobacterium tuberculosis — the bacterium that causes tuberculosis (TB) — and is a fundamental component of latent TB infection (LTBI) screening programs nationwide. Despite its clinical simplicity, 86580 generates significant billing confusion due to questions about what is bundled, when a separate reading visit can be billed, which diagnosis codes to use, and how Medicare handles coverage .

1. Code Definition, Clinical Procedure & What Is Bundled

Official AMA CPT Descriptor: Skin test; tuberculosis, intradermal

CPT 86580 falls under the Pathology and Laboratory section of the CPT code set, specifically within the range for Qualitative or Semiquantitative Immunoassays. This placement is important: the code represents a laboratory/diagnostic skin test, not a vaccine or immunization, and therefore follows laboratory billing rules — not immunization administration rules.

The Clinical Procedure

The TST (Mantoux method) is performed in three steps:

• Administration (Day 1): A clinician or trained nurse injects 0.1 mL of tuberculin purified protein derivative (PPD) intradermally — typically into the volar surface of the forearm — raising a small wheal (bleb) of approximately 6–10 mm.
• Waiting Period: The patient is instructed to return in 48–72 hours. Reading outside this window is considered invalid and should not be documented as a result.
• Reading (Day 2–3): A clinician or qualified nursing staff measures the induration (not erythema/redness) at the injection site in millimeters. The result is interpreted as positive, negative, or indeterminate based on the patient’s risk category and induration threshold.

What CPT 86580 Includes (Bundled)

CPT 86580 is an all-inclusive code for the placement/administration portion of the test. The following are bundled into 86580 and must NOT be billed separately:

• The PPD antigen material (purified protein derivative)
• The intradermal injection (administration) of the antigen Critical Bundling Rule: Do NOT add CPT 96372 (therapeutic, prophylactic, or diagnostic injection) or CPT 90471 (vaccine/toxoid administration) alongside 86580. Both are incorrect and will result in a denial or audit flag. 96372 is for distinct therapeutic injections only — not for the PPD antigen injection that is already captured by 86580. 90471 is exclusively for vaccines/toxoids; PPD is neither .

2. Billing the Return Reading Visit (99211)

The reading of the TB skin test — performed 48 to 72 hours after placement — is where billing practices differ most significantly across providers and payers.

The AMA and AAP Position

Per guidance from the American Academy of Pediatrics (AAP) and clarification in coding resources, the reading of the PPD test is NOT included in 86580. This is because the CPT code covers the skin test (placement/administration), while the interpretation is a separate clinical encounter involving the patient returning to the office and having a qualified staff member evaluate and document the site .

Billing for the Reading

If a patient returns to the office solely for the TST reading, you may report CPT 99211 (Office or other outpatient visit, established patient, minimal presenting problem — typically performed by ancillary staff) on that date of service. To support 99211, the nurse or clinician must document:

• Date and time of return visit
• Measurement of induration in millimeters (e.g., “0 mm induration — negative”)
• Clinical interpretation (negative/positive/indeterminate)
• Risk category used to determine the threshold for positivity
• Patient instructions provided Payer-Specific Variation: Some payers (notably HMSA and certain Medicaid plans) consider the reading included in 86580 and will deny a separately billed 99211. Always verify payer-specific policy before billing the reading visit. A single phone call to provider relations or a quick review of the payer’s fee schedule policy for 86580 can prevent denials .

Positive TST Result — Escalating the E/M Level

If the TST returns positive, a more complex evaluation is warranted — the provider reviews clinical history, orders additional workup (e.g., chest X-ray, sputum smear/culture, QuantiFERON confirmatory testing), and discusses LTBI treatment. In these cases:

• If the positive test triggers a medically necessary office visit with the physician, an appropriate E/M code (e.g., 99213–99214) can be reported instead of 99211, with modifier -25 appended if other procedures are performed that same day.
• Use diagnosis code R76.11 (Nonspecific reaction to tuberculin skin test without active tuberculosis) for a positive TST without confirmed active disease.
• If active TB is confirmed, use the appropriate code from the A15–A19 range.

3. ICD-10 Diagnosis Codes for CPT 86580

Proper ICD-10 coding is essential to establish medical necessity and prevent denials. The correct code depends on why the test is being performed and what the result is.

4. Medicare & Payer Coverage Rules

Medicare Part B

CPT 86580 is not a standard covered preventive benefit under Medicare Part B. Unlike influenza vaccines or colorectal cancer screenings, TB skin testing does not appear on Medicare’s preventive services list as a routinely covered, zero-cost-sharing benefit for average-risk beneficiaries .

However, Medicare may cover 86580 when the test is medically necessary — meaning there is a clinical indication documented in the medical record. Medically necessary indications that typically support coverage include:

• Known or suspected recent TB exposure (contact investigation)
• HIV-positive status or immunosuppressed condition requiring LTBI screening
• Recent immigration from a high-prevalence country
• Persons initiating treatment with TNF inhibitors or other immunosuppressive biologics (e.g., prior to starting adalimumab, infliximab)
• Residents or staff of long-term care facilities, homeless shelters, or correctional institutions
• Persons with diabetes, chronic renal failure, or other conditions that increase TB risk Advance Beneficiary Notice (ABN) — Best Practice: When a Medicare beneficiary requests a TST for employment, school clearance, or other non-medical reasons, Medicare will almost certainly not cover the service. Obtain a signed ABN (CMS Form CMS-R-131) before performing the test. Append modifier -GY (service is statutory exclusion) or -GA (ABN on file) as appropriate to the claim for 86580 so the patient can be billed directly .

Medicaid

Medicaid coverage varies by state. Most state Medicaid programs cover 86580 for medically necessary indications and, in many states, for mandated screening of healthcare workers, childcare workers, and school employees. In EPSDT (Early and Periodic Screening, Diagnostic and Treatment) encounters for children, some state Medicaid programs bundle 86580 into the global EPSDT visit fee — verify with your state’s Medicaid provider manual before billing separately.

Commercial Insurance

Most commercial payers cover 86580 under the lab/diagnostic benefit with standard cost-sharing. Employment- and school-related TSTs are increasingly covered under ACA-compliant plans when documented as preventive care using Z11.1. Some plans require a physician order for reimbursement.

EPSDT (Pediatric Medicaid) Special Consideration

In states where EPSDT lab services are bundled, separately billing 86580 alongside the well-child E/M code will trigger a denial. In states where 86580 is billable separately (such as Arizona/AHCCCS), bill it independently from the E/M. Always review your specific state Medicaid policy .

5. Modifier Usage for CPT 86580

Modifier 25 — Significant, Separately Identifiable E/M on the Same Day

Use modifier 25 appended to an E/M code (NOT to 86580 itself) when a physician performs a separately documented and medically necessary evaluation and management service on the same date as the TST. The E/M must address a problem or concern distinct from — or significantly beyond — the TB screening itself.

Example: A patient presents for an annual wellness exam. The provider also administers a TST as part of occupational health requirements. Bill the wellness E/M with any applicable preventive care code, and separately bill 86580 with modifier 25 attached to the E/M. Actually — modifier 25 goes on the E/M code, not on 86580. Many coders make the error of appending -25 to the procedure code.

Modifier 59 — Distinct Procedural Service

Modifier 59 is occasionally required when 86580 is billed alongside another immunology or skin test on the same date and the payer’s NCCI (National Correct Coding Initiative) edits bundle the codes. When two separate skin tests or immunoassays are performed on the same date for distinct clinical indications, append modifier 59 to the secondary code (not 86580, which is the dominant test) to indicate a distinct and separate service.

Caution: Several coders incorrectly append -59 to 86580 when billed with a wellness visit. This is not needed — 86580 and a preventive E/M code do not trigger NCCI edits with each other.

Modifier GY — Statutory Medicare Exclusion

Append modifier GY to 86580 when the test is being performed for an employment, school, or travel-related reason for a Medicare beneficiary — services statutorily excluded from Medicare benefits. This allows the patient to receive a non-covered service and be billed directly.

Modifier GA — ABN on File

Use modifier GA when a signed ABN is on file and there is reason to believe Medicare may deny the service as not medically necessary (i.e., for a marginal indication). This modifier protects the practice and informs Medicare that the patient has acknowledged potential financial responsibility .

Modifier KX — Medical Necessity Requirement Met

Some Local Coverage Determinations (LCDs) for lab services require modifier KX to affirm that the clinical criteria for coverage are met and documented in the record before Medicare will reimburse. Verify whether your MAC (Medicare Administrative Contractor) requires KX for 86580 under applicable LCDs.

6. Audit-Proof Documentation Standards

Because CPT 86580 is straightforward, auditors typically look for very specific documentation elements. Incomplete records are the most common reason for retrospective recoupment demands.

Required at the Time of Placement (Day 1):

• Order / Indication: Document the clinical reason for the test (e.g., “TST ordered for pre-employment screening per occupational health requirements,” “TST ordered for immunosuppressed patient prior to initiation of adalimumab,” or “screening ordered due to recent exposure to confirmed TB case”).

• Lot Number & Expiration Date: Record the PPD product name, lot number, and expiration date. This is a regulatory and liability requirement, especially in public health settings.

• Injection Site: Document the anatomical site (e.g., “volar surface, right forearm”).

• Dose and Route: “0.1 mL tuberculin PPD injected intradermally; wheal raised.”

• Return Instructions: Document that the patient was instructed to return in 48–72 hours for reading and to avoid rubbing or covering the site. Required at the Reading Visit (Day 2–3):

• Date and Time: Confirm the reading occurred within the valid 48–72 hour window.

• Measurement: Document the transverse diameter of induration in millimeters — not redness. Example: “Induration measured at 0 mm — negative result per criteria for low-risk individual.” Or: “Induration 14 mm — positive per ≥10 mm threshold for recent immigrant from high-prevalence country.”

• Interpretation Criteria Used: State the threshold applied and why (CDC 5 mm / 10 mm / 15 mm tiers based on risk category).

• Patient Notification: Note that the patient was informed of the result and given instructions for follow-up if positive. Documentation Pitfall — “TB test negative” Is Not Enough: A note reading only “PPD negative — no follow-up needed” does not support a 99211 billing for the reading visit. The note must demonstrate that a clinical evaluation occurred: induration was measured, the appropriate threshold was applied, and the patient received clinical guidance. A vague notation exposes your practice to a recoupment demand on audit.

7. Two-Step Testing (Healthcare Workers & High-Risk Populations)

The two-step TST is standard practice for baseline TB screening of healthcare workers, long-term care staff, correctional facility employees, and other individuals who undergo periodic TST testing.

Why Two-Step?

Some individuals with true latent TB infection may show a falsely negative initial TST due to immune system waning over time — a phenomenon called the “booster effect.” In such cases, the first TST acts as an immune system “reminder,” and the second TST placed 1–3 weeks later may show a positive result. The two-step test prevents the subsequent positive from being misclassified as a new TB conversion (which would trigger a costly contact investigation) .

Billing Two-Step TST

Each step of a two-step TST is billed as a separate encounter:

• Step 1 Placement: Bill 86580 with Z11.1 on Day 1.
• Step 1 Reading: Bill 99211 with Z11.1 on Day 2 or 3.
• Step 2 Placement: Bill 86580 again (1–3 weeks later) with Z11.1. Some payers require a documentation note (or field 19 notation on the claim) explaining that this is Step 2 of a two-step protocol to prevent denial for a “duplicate” test.
• Step 2 Reading: Bill 99211 with Z11.1 (or R76.11 if positive) on the reading date. Claim Note for Two-Step Protocol: When submitting the second 86580, include a narrative note in Box 19 of the CMS-1500 form (or the equivalent EHR field) stating: “Step 2 of two-step baseline TST protocol per CDC guidelines for healthcare worker.” This reduces the likelihood of duplicate-claim denial from automated payer claim scrubbers.

8. Detailed Comparison: CPT 86580 vs 86480 vs 86481 (IGRA Tests)

Providers frequently must choose between the traditional TST (86580) and the newer blood-based Interferon Gamma Release Assays (IGRAs: 86480 and 86481) for TB screening. Each has distinct clinical advantages, patient populations where they are preferred, and billing implications.

CDC Guidance on Test Selection: The CDC and USPSTF both recognize TST and IGRAs as acceptable for LTBI screening. IGRAs are preferred for BCG-vaccinated individuals and those unlikely to return for TST reading (e.g., homeless populations, transient workers). TST is often preferred for children under age 5, where blood draw is difficult, and in settings with strong TST infrastructure .

9. Clinical Billing Scenarios

Scenario 1: Pre-Employment Healthcare Worker Screening (Two-Visit)

Patient: 28-year-old new hospital employee, no prior TB history, no BCG vaccination.

Day 1: Nurse administers TST. No prior E/M needed.

Day 3: Nurse reads result: 0 mm induration — negative.

Coding Day 1: 86580 / Z11.1.

Coding Day 3: 99211 / Z11.1 (nurse documents measurement, interpretation, and counseling in chart).

Rationale: 86580 covers placement and PPD material. 99211 for reading visit is supported by documented clinical assessment. No modifier needed. Some payers will bundle 99211 into 86580 — check your payer contracts .

Scenario 2: Positive TST in a Patient Starting Adalimumab

Patient: 55-year-old with rheumatoid arthritis scheduled to begin adalimumab (Humira). Physician orders TST per guidelines before initiating TNF inhibitor therapy.

Day 1: TST placed.

Day 3: Induration measured at 12 mm — positive. Physician evaluates patient, reviews prior exposure history, orders chest X-ray, and discusses LTBI treatment options (isoniazid preventive therapy).

Coding Day 1: 86580 / Z11.1.

Coding Day 3: 99213-25 / R76.11 (E/M for evaluation of positive TST + 86580 was placed Day 1; Day 3 visit is purely E/M, no procedure billed).

Alternative Approach: If confirmatory QuantiFERON is ordered on Day 3, add 86480 / R76.11.

Rationale: R76.11 replaces Z11.1 once a positive result is documented. A separate E/M on the reading day is appropriate because the physician — not just nursing staff — evaluated the patient and made treatment decisions .

Scenario 3: TST on the Same Day as a Well-Child Visit

Patient: 5-year-old presenting for 5-year well-child exam. Pediatrician places TST as part of AAP-recommended LTBI screening for children with risk factors (parent recently immigrated from high-prevalence country).

Coding: Bill the appropriate well-child preventive E/M code (e.g., 99394 for 5–11 years) AND separately bill 86580 / Z11.1. Append modifier -25 to the E/M code if any problem-oriented service is also documented.

Note: The AAP supports billing 86580 separately from the preventive visit. No modifier is needed on 86580 itself. Do not add a vaccine administration code (90471) .

Scenario 4: Medicare Patient — Employment TST (Non-Covered)

Patient: 67-year-old Medicare beneficiary who volunteers at a daycare and is required by the daycare to have an annual TB test.

Action: Obtain a signed ABN before the test. Explain that Medicare will not cover TB testing for employment or voluntary work requirements.

Coding: Bill 86580 / Z11.1 with modifier -GA (ABN on file). The claim will be denied by Medicare, and the patient is responsible for payment.

Rationale: Without an ABN and modifier GA, if Medicare denies the claim, the provider may be required to write off the charge entirely. The ABN creates the contractual basis for patient billing .

10. Common Denial Reasons & How to Fix Them