0086U CPT Accelerate PhenoTest BC Reimbursement

CPT code 0086U is a Proprietary Laboratory Analyses (PLA) code for the Accelerate PhenoTest™ BC kit, an rRNA FISH-based assay that identifies organisms and assesses antimicrobial susceptibility directly from positive blood culture specimens. The code designates a single manufacturer-specific laboratory test used in the diagnosis and management of bloodstream infections, supporting targeted antimicrobial therapy decisions. Nationwide, PLA codes like 0086U matter because they link unique commercial assays to billing and coverage pathways, affecting laboratory adoption and clinical workflows.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical purpose and operational setting for the test, plus what to expect in payer coverage conversations and coding practice. The publication includes benchmark and coverage perspectives, typical service settings, and policy-relevant context for hospitals and clinical laboratories considering use of the Accelerate PhenoTest™ BC kit.

The report does not provide state-specific guidance. Data not available in the input is noted where applicable, and readers will gain a clear, national-level briefing on the code's clinical role and payer environment.

Billing Code Overview

CPT code 0086U is a Proprietary Laboratory Analyses (PLA) code for the Accelerate PhenoTest™ BC kit from Accelerate Diagnostics, Inc. The test uses rRNA fluorescence in situ hybridization (FISH) analysis of positive blood culture specimens to identify and determine susceptibility or resistance of six or more organisms to specific antimicrobial agents.

Service type: Laboratory diagnostic test — infectious disease pathogen identification and antimicrobial susceptibility testing

Typical site of service: Clinical laboratory or hospital microbiology laboratory processing positive blood culture specimens

Clinical Context

A hospitalized adult patient presents with fever, hypotension, and suspected sepsis after a recent invasive procedure. Blood cultures drawn in the emergency department turn positive on automated culture monitoring. The microbiology laboratory receives the positive blood culture bottle and performs the Accelerate PhenoTest™ BC assay to rapidly identify organisms and determine susceptibility or resistance to a panel of antimicrobial agents. Results from 0086U guide antimicrobial stewardship and early targeted therapy; the workflow includes specimen accessioning, preparation of the positive blood culture aliquot, placement on the Accelerate Pheno system, automated rRNA FISH-based identification and phenotypic susceptibility readout, result verification by a clinical microbiologist, and transmission of results into the electronic medical record and to the treating team.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when reporting only the professional interpretation component if split billing applies and the laboratory charges separately for interpretation.
`52`	Reduced services

Taxonomy Code	Specialty	Notes
207Q00000X	Pathology & Laboratory Medicine	Clinical microbiologists and laboratory directors overseeing the PLA testing.
208000000X	Emergency Medicine	Ordering clinicians who obtain blood cultures in patients with suspected sepsis.
207R00000X	Infectious Disease	Consultants interpreting rapid ID/susceptibility results and guiding therapy.
363LP0800X	Clinical Laboratory Technologist/Technician	Personnel performing the Accelerate PhenoTest™ BC assay and instrument operation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`A41.9`	Sepsis, unspecified organism	Common indication for blood culture and rapid identification/susceptibility testing to guide therapy.
`A41.0`	Sepsis due to Staphylococcus aureus	Target organism frequently identified by blood culture assays; rapid ID assists early targeted therapy.
`B37.7`	Candidemia	Fungal bloodstream infection that may be evaluated with culture-based rapid identification systems.
`R65.20`	Severe sepsis without septic shock	Clinical scenario prompting blood culture and susceptibility testing.
`R73.9`	Abnormalities of blood chemistry, unspecified	Lab abnormalities that often accompany systemic infection and prompt comprehensive testing.
`T81.4XXA`	Infection following a procedure, initial encounter	Post-procedural bloodstream infection scenario where rapid organism ID and susceptibility are indicated.
`Z16.11`	Resistance to penicillin	Antimicrobial resistance codes relevant when susceptibility results show resistance patterns affecting therapy choice.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`80053`	Comprehensive metabolic panel	Routine laboratory panel often ordered concurrently for septic patients to assess organ function and guide management.
`87040`	Culture, bacterial; blood, aerobic, per specimen	Standard blood culture processing and set-up that precedes or accompanies rapid molecular/phenotypic PLA testing.
`87428`	Infectious agent detection by nucleic acid (e.g., rRNA), multiple organisms, direct probe technique, amplified probe technique, or similar (Note: payer-specific)	Molecular identification assays that may be performed alongside or as alternatives to `0086U` depending on laboratory capabilities.
`99000`	Handling and/or conveyance of specimen (may be billed as administrative)	Ancillary handling or courier charges associated with transporting blood culture specimens to the testing laboratory.
`G0463`	Hospital outpatient clinic visit for the evaluation and management of a patient	Represents the clinical encounter in hospital outpatient settings where blood cultures are obtained and testing ordered.

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Summary & Overview

CPT 0086U: Accelerate PhenoTest BC rRNA FISH Blood Culture Identification and Susceptibility