Summary & Overview
CPT 86000: Serologic Test for Febrile Agglutinins
CPT code 86000 represents a clinical laboratory serologic test for febrile agglutinins that identifies antibodies to infectious agents such as Brucella, Francisella, Q fever, Rocky Mountain spotted fever, scrub typhus, and murine typhus. This code is used to report the technical laboratory procedure performed on a blood specimen and is reported separately for each antigen tested. Nationally, such serologic testing supports diagnosis of select zoonotic and rickettsial febrile illnesses and plays a role in infectious disease surveillance and clinical management.
Key payers in scope include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarks and clinical context related to laboratory service reporting, payer coverage considerations, and typical sites of service for CPT code 86000. The publication outlines how the code is applied in practice, what clinical scenarios prompt testing, and where data are unavailable in the input. Policy updates and payer-specific coding rules that affect laboratory reporting are summarized to help payers, coders, and laboratory managers understand common billing implications at a national level.
The content provides a concise reference for billing staff and laboratory administrators about the clinical purpose of CPT code 86000, typical service settings, and the scope of reporting when multiple antigens are tested.
Billing Code Overview
CPT code 86000 describes a serologic laboratory test in which a lab analyst performs the technical procedure to analyze a blood specimen for febrile agglutinins. The test detects antibodies (agglutinins) against agents that cause febrile illnesses, including Brucella, Francisella, murine typhus, Q fever, Rocky Mountain spotted fever, scrub typhus, and others. Report CPT code 86000 for each antigen tested.
Service type: Clinical laboratory serologic testing (technical component)
Typical site of service: Clinical laboratory or hospital laboratory processing blood specimens
Clinical & Coding Specifications
Clinical Context
A 42-year-old farmer presents to the primary care clinic with fever, headache, myalgias, and a recent history of tick exposure and unpasteurized dairy consumption. The clinician orders serologic testing for febrile agglutinins to evaluate for rickettsial and other zoonotic infections (for example, Rocky Mountain spotted fever, murine typhus, Q fever, and Brucella). A phlebotomy technician collects a blood specimen, which is sent to the hospital reference laboratory. A laboratory technologist performs agglutination assays and interpretation of each antigen tested. Results are reported in the electronic health record to the ordering provider, who integrates serology with clinical findings to guide further management (additional diagnostic tests, empiric therapy, or public health reporting). Typical site of service is an outpatient clinic, urgent care, hospital outpatient lab, or reference laboratory performing infectious disease serology.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional Component | Use when billing for the physician interpretation component if separated from the technical testing. |
TC | Technical Component | Use when billing only the laboratory technical component for specimen processing and testing. |
59 | Distinct Procedural Service | Use when this test is separate and distinct from another service billed on the same day. |
90 | Reference Laboratory | Use when laboratory testing is performed by a separate, independent reference laboratory. |
91 | Repeat Clinical Diagnostic Test (Not provided in input) | Data not available in the input. |
52 | Reduced Services | Use when the laboratory performed a reduced scope of the full test for clinical reasons. |
53 | Discontinued Procedure | Use if specimen processing was started but the test was discontinued for documented clinical reasons. |
78 | Unplanned Return to the Operating/Procedure Room | Use: Data not applicable for this laboratory test; include only if relevant surgical/procedural context exists. |
59 (alternate listed) | See above | See above |
QW | CLIA Waiver (Not provided in input) | Data not available in the input. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207R00000X | Infectious Disease Specialist | Physicians who order and interpret complex serologic panels for zoonotic infections. |
| 207L00000X | Pathology & Laboratory Medicine | Laboratory directors and pathologists overseeing serologic assay validation and interpretation. |
| 363A00000X | Clinical Laboratory Technologist | Technologists performing agglutination testing and reporting technical results. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
A78 | Q fever | Serologic agglutination testing can detect antibodies to Coxiella burnetii in acute or chronic Q fever. |
A23 | Brucellosis | Brucella agglutinins are detected by agglutination assays to confirm brucellosis in exposed patients. |
A75.3 | Rickettsialpox | Rickettsial infections (including Rocky Mountain spotted fever and murine typhus) are evaluated with febrile agglutinin serology. |
A77 | Spotted fever (tick-borne rickettsioses) | Serology assists diagnosis of spotted fever group rickettsioses when clinical exposure and signs suggest infection. |
A49.9 | Bacterial infection, unspecified | Used when a bacterial zoonosis is suspected but organism not yet identified; serology aids in etiologic diagnosis. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
36415 | Collection of venous blood by venipuncture | Commonly performed immediately before 86000 to obtain the specimen for serologic testing. |
87520 | Infectious agent antigen detection by immunofluorescent technique, multiple organisms (if applicable)` | May be performed alongside serology when direct antigen detection is indicated. |
86580 | Skin test, tuberculosis; intradermal (Mantoux) | Not directly related but an example of infectious disease testing performed in the same clinical workup for febrile patients. |
87070 | Culture, bacterial; quantitative colony count, urine (non-blood)` | Used in parallel investigations when bacterial causes of fever are considered; performed in the same diagnostic workflow. |
81002 | Urinalysis, non-automated without microscopy | Often performed as part of the initial workup for febrile illness in outpatient settings. |