CPT 86803: Hepatitis C Antibody Immunoassay in Serum
Commercial payers pay $39 on average nationally for this procedure.
CPT code 86803 describes an immunoassay laboratory test performed by a clinical lab analyst to detect antibodies to Hepatitis C virus (HCV) in a patient’s serum; service type: serologic antibody testing; typical site of service: clinical laboratory or hospital laboratory processing serum specimens for infectious disease screening and diagnosis.
For related coverage guidance, see recent payer policy updates: Allergy Testing, Including Selected Blood, Serum and Cellular Testing and Toxicity Testing Corporate Medical Policy, Allergy Testing and Injections, Allergy Testing.
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National Reimbursement Benchmarks
National commercial reimbursement for CPT 86803 centers around BUCA’s average commercial benchmark of $39.20, with individual payer patterns showing meaningful variation. Blue Cross Blue Shield posts the highest dispersion between its 25th and 75th percentiles (P75 $68.90 minus P25 $47.00 = $21.90), indicating broader negotiated spread, while Aetna and Cigna show moderate variability (Aetna P75 $19.90 minus P25 $10.60 = $9.30; Cigna P75 $20.70 minus P25 $8.00 = $12.70). UnitedHealth Group exhibits the tightest interquartile spread (P75 $14.30 minus P25 $6.30 = $8.00), reflecting more clustered commercial rates.
Payor-level medians and extremes emphasize differences in central tendency: Blue Cross Blue Shield’s median is $52.60 and its max reaches $198.90, contrasting with UnitedHealth Group’s median of $8.60 and max of $54.30. Aetna’s mean of $18.40 and Cigna’s mean of $15.50 sit below BUCA’s mean, while UnitedHealth Group’s mean of $12.40 is the lowest among listed payers, illustrating a spread of average reimbursements around the BUCA commercial benchmark.