CPT code 86580 – Tuberculosis skin test, intradermal

Key takeaways

CPT code 86580 covers administering the tuberculosis skin test, and the 48-to-72-hour reading visit needs no second procedure code.

Pair 86580 with Z11.1 for routine screening, and use R76.11 when the result is nonspecific.

Total RVU is 0.33, and Medicare pays about $11.02 nationally in a non-facility setting.

Append modifier -25 to the E/M code when a separate evaluation happens on the same date.

Practice management software like Pabau automates ICD-10 pairing, CPT entry, and superbill generation for TB screening claims.

CPT code 86580: Official description and code section

CPT code 86580 bills the intradermal tuberculosis skin test, usually called the PPD or Mantoux test. The official descriptor in the AMA CPT code set reads “Skin test; tuberculosis, intradermal”. The code sits in the Immunology section, inside the Skin Tests subsection.

It pays for injecting PPD antigen into the forearm dermis, and it is billed once, on the date of administration. The clinician’s interpretation of the wheal at the return visit carries no procedure code of its own. The table below sets out the reference data at a glance.

When to use CPT code 86580: Clinical indications

CPT code 86580 is appropriate when a clinician administers PPD antigen intradermally and the patient will return for interpretation. The most common settings are pre-employment and occupational health screenings. That covers healthcare workers, school employees, and food service workers wherever state or employer policy mandates annual TB testing.

• Pre-employment screening: Healthcare workers, school staff, and food handlers in jurisdictions requiring TB clearance
• Occupational health mandates: Annual or periodic testing programs in hospitals, nursing homes, and correctional facilities
• Symptom-driven evaluation: Patient presents with chronic cough, weight loss, or night sweats and the clinician orders TB screening
• Public health contact tracing: Individuals identified as close contacts of a confirmed TB case
• Immigration or travel medicine: Required TB screening for certain visa categories or travel programs

Do not use 86580 for: blood-based interferon gamma release assays (IGRAs) such as QuantiFERON or T-SPOT.TB. Those tests use CPT 86480 and 86481 respectively. Billing 86580 for a blood draw is a category error that triggers denial. The comparison section below sets out how to choose between the three codes.

How to bill CPT code 86580 correctly: Step-by-step

The workflow for CPT code 86580 splits across two visits, but only one CPT code is required. Keeping that distinction straight prevents most of the errors listed further down.

1. Administer the test intradermally. Inject 0.1 mL of PPD antigen into the volar surface of the forearm using the Mantoux method. Document the lot number, expiration date, manufacturer, injection site, and date of administration.
2. Bill CPT 86580 on the date of administration. Submit the claim with the appropriate ICD-10 diagnosis code, covered in the pairing section below. The date of service is the administration date, not the reading date.
3. See the patient 48 to 72 hours later for the reading. Measure and document the induration diameter in millimeters. Record the interpretation as positive, negative, or indeterminate. No additional procedure code is billed for the reading itself.
4. Bill a separate E/M code only if warranted. Where the reading visit also includes a separately identifiable evaluation and management service, bill the E/M code with modifier -25. Reading the result alone does not support an E/M charge.

Coders new to occupational health often assume the reading is a second billable procedure. It is a documentation step, and CPT code 86580 has already paid for the test by the time the patient returns.

ICD-10 diagnosis codes to pair with CPT code 86580

Pairing CPT code 86580 with the correct ICD-10-CM diagnosis code is a prerequisite for clean claim submission. The right code depends on the clinical reason for testing, not on the test result. Check the CDC ICD-10-CM web tool to confirm current code validity before you submit.

Z11.1 is the correct primary pairing for the large majority of CPT code 86580 encounters. Use it for routine, occupational, and pre-employment screening unless a more specific clinical reason applies. Screening, exposure, and result codes sit in different chapters. The ICD-10-CM codes index is worth checking when the reason for the test is not plain screening.

Submitting an active TB code such as A15.x when the purpose was screening creates a medical necessity mismatch. That mismatch is one of the few reliable ways to attract a payer audit on a code this small.

CPT code 86580 fee schedule and reimbursement rates (2026)

The 2026 national Medicare payment for CPT code 86580 is about $11.02 in a non-facility setting, per the CMS Physician Fee Schedule. Actual payment varies by Medicare Administrative Contractor (MAC) locality, payer contract, and facility status. Use the CMS Physician Fee Schedule lookup to pull current locality-specific rates.

Private payers usually reimburse at or near Medicare rates for a code this low in complexity. Some managed care contracts apply a percentage of Medicare instead. Low-dollar codes still repay tracking, because a high-volume occupational health program bills hundreds of these tests a month.

RVU breakdown for CPT code 86580

The relative value units for CPT code 86580 reflect its low clinical complexity. Total RVU is 0.33, based on CMS Physician Fee Schedule data. Values are republished each year, so confirm them against the current release before you model program revenue.

Practice expense accounts for almost the whole payment, as the split below shows. That is unusual enough to change how a program should think about the code’s margin.

Applicable modifiers for CPT code 86580

Modifiers for CPT code 86580 are used sparingly. The code is straightforward, but two situations consistently require a modifier decision.

Modifier -25 goes on the E/M code, never on 86580. That distinction trips up new coders regularly. The reading visit at 48 to 72 hours does not routinely support an E/M charge. It qualifies only where the clinician documents a substantive assessment beyond the induration measurement.

Documentation requirements for CPT code 86580

Payers audit TB skin test claims primarily on documentation completeness. A chart note reading “PPD given”, with no supporting detail, will not satisfy most commercial and Medicare payers. Build the required fields into the encounter template so none of them is missed at administration.

The administration note must include all of the following:

• Clinical indication: Why the test is being performed (pre-employment, contact investigation, symptomatic screening)
• Antigen details: Tuberculin lot number, expiration date, and manufacturer
• Administration site: Specific forearm location (volar surface, left or right arm)
• Injection technique: Intradermal Mantoux method confirmed
• Return date instructions: Patient instructed to return in 48 to 72 hours for the reading

The reading note, documented at the return visit, must include:

• Induration measurement: Diameter in millimeters (erythema alone does not constitute a positive result)
• Reading date and time since administration
• Clinical interpretation: Positive, negative, or indeterminate, with the threshold applied (typically 5 mm, 10 mm, or 15 mm depending on patient risk category)
• Plan: Next steps if positive (chest X-ray, IGRA confirmation, referral to TB control)

Complete records across both notes protect the practice when a payer audits the account. Digital forms with required fields prevent the missing-lot-number denials that coders report repeatedly. Practice management software like Pabau lets a practice build a TB screening template whose mandatory fields are captured at the point of care.

Common billing errors with CPT code 86580 and how to avoid them

Five billing errors account for the majority of CPT code 86580 denials. Each one is preventable with a consistent encounter workflow.

• Billing a second code for the reading visit: CPT code 86580 is billed once, on the administration date. The 48-72 hour return needs no additional procedure code. Adding a second 86580 or an unrelated lab code doubles the claim incorrectly.
• Using 86580 for a blood-based IGRA test: QuantiFERON and T-SPOT.TB are blood draws, not intradermal injections. These use CPT 86480 and 86481 respectively. Billing 86580 on an IGRA claim contradicts the medical record and will deny on review.
• Wrong ICD-10 pairing: Submitting 86580 with an active TB diagnosis code (A15.x) when the clinical purpose was routine screening triggers a medical necessity review. Z11.1 is the correct primary pairing for screening.
• Missing induration measurement: Documenting a qualitative result such as “positive” or “negative”, without the induration diameter in millimeters, leaves the record incomplete. Some payers require the numeric value for audit purposes.
• Bundling errors with E/M on the same day: An E/M code billed without modifier -25 will bundle and deny when 86580 is on the claim. Modifier -25 belongs on the E/M code.

A clean first submission depends on the coder and the documenting clinician working from one checklist. Building a TB skin test encounter template into your practice management system is the most reliable way to standardize that.

CPT 86580 vs CPT 86480 vs CPT 86481: Choosing the right TB test code

Clinicians and coders sometimes conflate the three TB testing codes, since all three detect tuberculosis. The testing method determines the correct code, rather than the clinical indication. Use the AAPC Codify CPT lookup to confirm the current description for each one.

The CDC and USPSTF both recognize IGRAs as equivalent to the TST for most populations. For BCG-vaccinated patients, common among international travelers and immigrants, IGRAs are preferred because the vaccine causes false-positive skin test results. Substituting 86580 for 86480 or 86481 fails on review, because the method in the chart will not match the code billed.

CPT code 86580 in practice management software

Occupational health programs billing CPT code 86580 at volume need a system that automates the repetitive steps in each encounter:

• Entering the CPT code against the correct date of service
• Pairing it with Z11.1, or with the exposure code the visit calls for
• Generating the superbill
• Routing the claim to the clearinghouse

Manual workflows at that scale produce inconsistent documentation and missed modifiers. Pabau’s claims tools for practices handle CPT code entry and ICD-10 pairing inside the encounter. Nobody has to look up Z11.1 again for every TB screening visit.

The system generates the superbill and transmits claims electronically through Claim.MD, our US clearinghouse partner. Claim.MD connects to over 4,000 payers and validates claims against the CPT and ICD-10 catalogs before submission.

That pre-submission scrubbing catches the most common 86580 errors, such as a wrong diagnosis code or a missing modifier, before the claim reaches the payer. Practices running high-volume TB screening can also standardize the encounter template across every administering clinician. The documentation chain then holds from the antigen lot number through to claim submission.

Reduce claim denials on CPT code 86580

Pabau’s claims management software automates CPT code entry, ICD-10 pairing, and superbill generation, so TB screening claims go out clean on the first submission.

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Conclusion

CPT code 86580 is a straightforward code with a small, consistent set of pitfalls. Bill it once on the administration date, add no second code at the reading visit, and pair it with Z11.1 for routine screening.

Because the code carries no work RVU, what it returns depends on volume and on claims going out clean. For a program running hundreds of tests a year, two things repay attention first. Standardize the encounter template, then watch the first-pass acceptance rate.

Book a demo to see how Pabau keeps TB screening claims accurate, from the antigen lot number through to payment posting.

Continue your research

Need to understand the full claims submission process? Pabau’s Claim.MD clearinghouse guide explains how electronic claim routing and real-time eligibility checks work for US practices.

Struggling with claim denials on billing codes? Denial codes in medical billing breaks down the most common CARC denial reasons and how to respond to each one.

Building a TB screening documentation workflow? Medical billing compliance covers the documentation standards a payer audit tests, and how to hold them at the point of care.

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