Summary & Overview
CPT 86063: Antistreptolysin O (ASO) Serology, Technical Component
CPT code 86063 denotes the technical laboratory test to analyze serum for the presence of antistreptolysin O (ASO), a serologic marker used in assessing recent or prior streptococcal infection. Nationally, ASO testing supports diagnostic evaluation for post-streptococcal complications and rheumatologic or infectious disease workups, making accurate lab coding and billing important for care documentation and claims processing. Key payers relevant to coverage and reimbursement considerations include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
This publication provides a concise review of CPT code 86063: its clinical role, typical sites of service, and operational context for laboratories and billing teams. Readers will find benchmark framing for payer coverage (where available), common billing modifiers and service-line context, and the clinical indications that typically prompt ASO testing. The report also notes areas where input data is not available and highlights where clinicians and billing staff should consult payer-specific policies or local laboratory protocols for authorization, bundling, or documentation requirements.
Intended for laboratory managers, medical coders, and policy analysts, the article organizes essential information for efficient claim submission and clinical communication around ASO serology testing using CPT code 86063.
Billing Code Overview
CPT code 86063 describes a laboratory technical service in which a lab analyst performs testing to detect the presence of antistreptolysin O (ASO) in a serum sample. The service type is laboratory serology testing, and the typical site of service is a clinical laboratory or hospital laboratory where blood specimens are processed and analyzed.
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Clinical & Coding Specifications
Clinical Context
A school-aged child presents to a community outpatient clinic with a recent history of sore throat and fever two weeks earlier and now reports fatigue and joint aches. The clinician performs a focused history and physical exam noting a prior untreated streptococcal pharyngitis suspected by family report. A serum sample is collected via venipuncture and sent to the laboratory for antistreptolysin O (ASO) titer measurement to evaluate for recent Group A Streptococcus infection and possible poststreptococcal sequelae (for example, acute rheumatic fever or poststreptococcal reactive arthritis).
The clinical workflow: the provider orders 86063 on the laboratory requisition. A phlebotomist draws a serum specimen and labels it with patient identifiers. The specimen is transported to the clinical lab where a laboratory analyst performs the technical assay to quantify antistreptolysin O levels. Results are reported in the electronic medical record with interpretive reference ranges. The ordering provider reviews the result to correlate with clinical findings and documents the encounter and any follow-up plan.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician professional interpretation portion if separate from the lab technical component (rare for ). |