Summary & Overview

CPT 86037: ANCA Titer, Serum Quantitative

CPT code 86037 represents the quantitative titer for antineutrophil cytoplasmic antibodies (ANCA), used to measure serum antibody levels after a positive ANCA screen. This test has clinical importance for diagnosing and monitoring autoimmune vasculitis and related inflammatory disorders, as titers can inform clinicians about disease activity and treatment response. Nationally, ANCA testing is a common laboratory service with implications for specialty care pathways in rheumatology, nephrology, and immunology.

Key payers discussed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of billing and clinical context for CPT code 86037, standard sites of service, and how the test is typically ordered (reflex to titer following a positive screen). The publication also outlines common modifiers and payer coverage considerations where available, and provides benchmarks and policy-relevant notes to support billing compliance and clinical documentation. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare86037CPTANCA titerlaboratoryautoimmunevasculitisserologyreflex testing

Billing Code Overview

CPT code 86037 measures the serum level of an antineutrophil cytoplasmic antibody (ANCA) titer, which quantifies antibodies directed against neutrophil components. This test is performed when an initial ANCA screen is positive to determine the antibody concentration and can help clinicians monitor disease activity and response to therapy for autoimmune conditions such as vasculitis.

Service type: Laboratory diagnostic test — reflex quantitative antibody titer following a positive ANCA screen
Typical site of service: Clinical laboratory or hospital outpatient laboratory setting

Clinical & Coding Specifications

Clinical Context

A typical patient is a 52-year-old adult referred by a rheumatologist for evaluation of suspected systemic vasculitis after several weeks of constitutional symptoms, new-onset purpura, arthralgia, and declining renal function. The clinician orders an antineutrophil cytoplasmic antibody (ANCA) panel beginning with an ANCA screen and reflex to titer. A phlebotomy draw occurs in an outpatient laboratory or hospital inpatient setting; the specimen is processed by the laboratory immunology section, which performs the initial ANCA screen (often by indirect immunofluorescence or immunoassay) and, if positive, performs the quantitative titer reported under 86037. Typical sites of service include outpatient hospital laboratory, independent reference laboratory, outpatient clinic laboratory, or inpatient hospital laboratory when monitoring hospitalized patients. The clinical workflow includes: clinician documents signs/symptoms and orders ANCA screen with reflex to titer; phlebotomy collects serum; laboratory performs screen and reflex titer if positive; results are reported to ordering clinician to support diagnosis or monitor treatment response for conditions such as granulomatosis with polyangiitis, microscopic polyangiitis, or other ANCA-associated vasculitides.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when only the physician interpretation component is billed separately from the laboratory technical component.
`TC`	Technical component	Use when only the laboratory technical component is billed (instrumentation, reagents, processing).
`90`	Reference (outside) laboratory	Use when testing is performed by an outside/reference laboratory and billed by the ordering facility.
`91`	Repeat clinical diagnostic laboratory test	Use when the same test is repeated on the same day for clinical reasons (not for quality control).
`52`	Reduced services	Use when the test is partially reduced or not fully performed.
`59`	Distinct procedural service	Rare for lab codes; use only when distinct and separate service applies per payer rules.
`22`	Unusual procedural services (increased procedural services)	Use when additional work or complexity for the test requires additional documentation and may affect reimbursement.
`90`	Reference (outside) laboratory	Use when testing is performed by an outside/reference laboratory and billed by the ordering facility.
`QW`	CLIA waived test	Use if and only if the specific assay meets CLIA waived status and payer requires modifier (uncommon for ANCA titers).
`91`	Repeat clinical diagnostic laboratory test	Use when repeat testing is clinically necessary within a short interval.

Taxonomy Code	Specialty	Notes
207R00000X	Rheumatology	Rheumatologists commonly order ANCA testing for suspected vasculitis.
207L00000X	Allergy & Immunology	Specialists in immune-mediated disease who may order and interpret ANCA results.
2080P0003X	Clinical Pathology	Pathologists and laboratory directors oversee testing and interpretation policies for immunology assays.
363A00000X	Laboratory	Clinical laboratory professionals performing the technical component of the assay.
207K00000X	Nephrology	Nephrologists often order ANCA testing when renal involvement (rapidly progressive glomerulonephritis) is suspected.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M31.3`	Wegener granulomatosis (granulomatosis with polyangiitis)	ANCA testing supports diagnosis and monitoring of disease activity.
`M31.7`	Microscopic polyangitis	MPO-ANCA and PR3-ANCA testing assist in diagnosis and follow-up.
`N00.0`	Acute nephritic syndrome, with minor glomerular abnormality	Renal manifestations may prompt ANCA testing when vasculitis is suspected.
`R23.3`	Petechiae	Purpuric skin findings can be a presentation prompting ANCA evaluation.
`M35.3`	Polymyalgia rheumatica (Note: often evaluated in differential diagnosis)	Overlap in symptoms such as systemic inflammation may lead clinicians to order autoimmune serologies including ANCA to exclude vasculitis.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`86036`	Antineutrophil cytoplasmic antibody (ANCA) screen; qualitative or semiquantitative	The initial screening assay frequently ordered with reflex to `86037`; a positive `86036` triggers the titer reported by `86037`.
`86341`	Immunoassay for infectious agent antibody, quantitative or semiquantitative, each procedure	Laboratories may perform complementary immunoassays to evaluate differential diagnoses; represents other quantitative antibody assays.
`80103`	Drug screen, qualitative; multiple drug classes by high throughput method	Not directly related to ANCA but commonly performed in inpatient workups where multiple laboratory tests are ordered concurrently.
`99000`	Handling and/or conveyance of specimens for transfer from a physician's office to a laboratory	Administrative/billing code sometimes used when specimens are transported to an external lab for tests such as `86037`.
`84153`	Antibody; myeloperoxidase (MPO), quantitative	MPO-ANCA testing is commonly ordered with ANCA panels and reported separately if performed as antigen-specific quantitative assays.