Summary & Overview
CPT 86701: Hepatitis A Antibody (IgM) Laboratory Test
CPT code 86701 represents the laboratory test for Hepatitis A antibody (IgM), a crucial diagnostic tool for identifying acute Hepatitis A infection. This code is widely recognized across the United States and is commonly billed by independent laboratories. The test is vital for clinicians seeking to confirm recent exposure to the Hepatitis A virus, which can inform treatment and public health interventions.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, provide coverage for this laboratory service. The publication offers a comprehensive overview of payer policies, billing benchmarks, and recent updates relevant to laboratory providers and healthcare organizations. Readers will gain insight into the clinical context of Hepatitis A testing, typical sites of service, and the role of this code in broader hepatitis screening protocols. The summary also highlights related codes and common billing modifiers, equipping stakeholders with the information needed to understand the landscape of Hepatitis A antibody testing.
This article is designed for laboratory administrators, billing professionals, and policy analysts seeking a clear, concise summary of CPT code 86701 and its significance in national healthcare billing and coverage.
CPT Code Overview
CPT code 86701 is used to report the laboratory test for Hepatitis A antibody (IgM). This test is essential for detecting acute Hepatitis A infection, providing critical information for diagnosis and patient management. The service is classified as a laboratory procedure and is typically performed in an independent laboratory setting, designated as Place of Service 81. The test plays a key role in identifying recent exposure to the Hepatitis A virus and guiding clinical decisions.
Clinical & Coding Specifications
Clinical Context
A patient presents to their primary care provider with symptoms such as nausea, vomiting, fever, and elevated liver enzymes. The provider suspects acute viral hepatitis and orders laboratory testing to determine the cause. The independent laboratory collects a blood sample and performs the Hepatitis A antibody (IgM) test (86701) to detect recent infection. The results assist the provider in confirming or ruling out acute Hepatitis A, guiding further management and infection control measures.
Coding Specifications
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Modifiers:
Modifier Code Description Usage Context 59Distinct Procedural Service Used when the Hepatitis A antibody (IgM) test is performed separately from other procedures, indicating it is not bundled with other services. 91Repeat Clinical Diagnostic Laboratory Test Used when the same test is repeated on the same patient to monitor changes or confirm results.