Summary & Overview
CPT 86702: Laboratory Testing for HIV‑2 Antibody
CPT code 86702 represents laboratory testing for HIV‑2 antibodies, a vital tool in the detection and differentiation of HIV infections. This code is widely used in clinical laboratories to support accurate diagnosis and inform patient management, especially in cases where distinguishing between HIV‑1 and HIV‑2 is clinically relevant. The test is typically performed in laboratory settings and is recognized by major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.
This publication provides a comprehensive overview of 86702, including payer coverage, clinical context, and related coding benchmarks. Readers will gain insight into the role of HIV‑2 antibody testing in preventive screening, diagnostic workflows, and its importance in public health. The analysis also highlights common billing practices, such as the use of modifier 33 for preventive services, and reviews associated taxonomies and ICD-10 diagnoses relevant to HIV testing. Additionally, related CPT codes are discussed to clarify distinctions in laboratory reporting for HIV and other infectious agents.
Healthcare professionals, laboratory administrators, and policy stakeholders will find this summary useful for understanding national coverage trends, coding updates, and the clinical significance of HIV‑2 antibody testing in laboratory medicine.
CPT Code Overview
CPT code 86702 is used to report laboratory testing for the detection of antibodies specific to HIV‑2. This test is a critical component in the diagnosis and management of human immunodeficiency virus (HIV) infections, particularly distinguishing HIV‑2 from HIV‑1. The service is classified under Laboratory / Pathology and is typically performed in a laboratory setting, such as Place of Service (POS) 19. Accurate identification of HIV‑2 antibodies supports clinical decision-making and public health surveillance efforts.
Clinical & Coding Specifications
Clinical Context
A patient presents to a family medicine or internal medicine clinic for routine screening or evaluation related to human immunodeficiency virus (HIV). The provider orders laboratory testing to detect antibodies specific to HIV‑2. The specimen is collected and sent to a clinical medical laboratory (Place of Service 19), where the laboratory performs the antibody test using CPT code 86702. This workflow is typical for preventive screening, evaluation of exposure, or confirmation of HIV infection status, especially in patients with risk factors or inconclusive prior results.
Coding Specifications
- Modifier
33: Used to indicate a preventive service, such as preventive HIV‑2 antibody screening. This modifier is applied when the test is performed as part of a preventive health encounter.
| Provider Taxonomy Code | Specialty Description |
|---|---|
291U00000X | Clinical Medical Laboratory |
207Q00000X | Family Medicine Physician |
207R00000X | Internal Medicine Physician |
- Clinical Medical Laboratory: Performs laboratory testing and analysis.
- Family Medicine Physician: Orders and interprets laboratory tests for general patient care.
- Internal Medicine Physician: Orders and interprets laboratory tests for adult patients.
Related Diagnoses
-
Z21— Asymptomatic human immunodeficiency virus [HIV] infection status- Used when a patient is known to be HIV positive but has no symptoms; relevant for monitoring and follow-up testing.
-
B20— Human immunodeficiency virus [HIV] disease- Indicates symptomatic HIV infection; testing may be performed to confirm diagnosis or monitor disease progression.
-
R75— Inconclusive laboratory evidence of human immunodeficiency virus [HIV]- Used when previous HIV test results are indeterminate; further testing with
86702may clarify infection status.
- Used when previous HIV test results are indeterminate; further testing with
-
Z11.4— Encounter for screening for human immunodeficiency virus [HIV]- Applied when the test is performed as part of routine screening, often in preventive care settings.
-
Z20.6— Contact with and (suspected) exposure to human immunodeficiency virus [HIV]- Used when a patient has had possible exposure to HIV; testing is performed to assess infection risk.
Related CPT Codes
| CPT Code | Description | Clinical Relationship |
|---|---|---|
86701 | Antibody; HIV‑1 | Used for HIV‑1 antibody testing; often ordered alongside 86702 for comprehensive HIV screening. |
86703 | Antibody; HIV‑1 and HIV‑2, single result | Provides combined HIV‑1 and HIV‑2 antibody results; may be used as an alternative to separate 86701 and 86702 tests. |
86689 | Antibody; HTLV or HIV antibody, confirmatory test | Used as a confirmatory test following initial HIV antibody screening. |
87389 | Infectious agent antigen detection… HIV‑1 antigen(s), with HIV‑1 and HIV‑2 antibodies, single result | Detects HIV‑1 antigen and both HIV‑1 and HIV‑2 antibodies; may be used for initial screening or confirmation. |
87390 | Infectious agent antigen detection… HIV‑1 | Used for HIV‑1 antigen detection; may complement antibody testing. |
87391 | Infectious agent antigen detection… HIV‑2 | Used for HIV‑2 antigen detection; may complement antibody testing. |
- Codes
86701and86702are commonly ordered together for full HIV screening. - Code
86703is an alternative to ordering86701and86702separately. - Codes
86689,87389,87390, and87391are used for confirmatory or additional testing as clinically indicated.
National Reimbursement Benchmarks
For CPT code 86702, national mean rates among commercial payers are highest with Cigna at $16.53 and lowest with UnitedHealth Group at $11.54. The BUCA average commercial mean rate stands at $13.03, which is notably higher than typical Medicare rates for similar codes, though Medicare-specific data is not available in the input.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. UnitedHealth Group shows the tightest spread at $6.50, while Cigna exhibits the widest at $11.50, indicating greater variability in Cigna's contracted rates. Blue Cross Blue Shield and BUCA both have moderate dispersion, with ranges of $6.20 and $6.33, respectively.
The table and chart below present a detailed breakdown of national benchmarks for each payer.
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