Summary & Overview

CPT 86146: Beta 2 Glycoprotein I Antibody Laboratory Test

CPT code 86146 represents the laboratory technical component for testing a specimen, typically serum, for the presence of beta 2 glycoprotein I antibody. This immunologic assay is used in the evaluation of antiphospholipid antibody profiles and can influence diagnosis and management of thrombotic and autoimmune conditions. As a technical lab procedure, it captures the analytic work performed by laboratory personnel and the use of laboratory equipment and reagents.

Key national payers included in the coverage context are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find information on the clinical purpose of the test, common sites where the service is performed, and payer relevance for laboratory billing. The publication also provides benchmarks and coverage context for laboratories and billing professionals, along with notes on reporting units and how the code is typically used in immunology testing panels.

The analysis is intended to help laboratory managers, billing staff, and policy analysts understand the role of CPT code 86146 in routine immunologic testing workflows, the typical clinical contexts in which the test is ordered, and the payer landscape that shapes coverage and claims processing nationally.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare86146CPTLaboratoryImmunologyBeta 2 Glycoprotein IAntibody TestingTechnical ComponentClinical LaboratorySerology

Billing Code Overview

CPT code 86146 describes a laboratory technical procedure in which a lab analyst performs an assay to analyze a patient specimen, such as serum, for the presence of beta 2 glycoprotein I antibody. The code is reported one unit for each antibody tested.

Service Type: Laboratory diagnostic test (technical component)

Typical Site of Service: Clinical laboratory or hospital laboratory

Clinical & Coding Specifications

Clinical Context

A 34-year-old female with a history of recurrent first-trimester pregnancy loss and a prior unexplained thrombotic event presents for a hypercoagulability evaluation. The clinician orders antiphospholipid antibody testing, including beta-2 glycoprotein I IgG and IgM. A phlebotomy technician draws a serum sample at an outpatient laboratory. The specimen is transported to the clinical laboratory where a medical laboratory scientist or lab analyst performs the 86146 assay to detect beta-2 glycoprotein I antibody in the serum. The laboratory documents one unit reported per antibody tested. Results are transmitted to the ordering clinician who integrates antibody status with clinical history to support or exclude antiphospholipid syndrome and guide peri‑pregnancy or anticoagulation management. Typical site of service: outpatient laboratory or hospital clinical laboratory. Service type: clinical immunology/serology laboratory testing (technical component). Typical patient scenario: adult patient evaluated for thrombosis or recurrent pregnancy loss where antiphospholipid antibodies are suspected.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician or pathologist professional interpretation of the test result separate from the lab's technical processing.
`TC`	Technical component	Use when billing only the laboratory technical component (instrumentation, reagents, tech time) — common for hospital labs or reference labs.
`90`	Reference (outside) laboratory	Use when the performing lab is an outside independent reference laboratory contracted by the ordering facility.
`91`	Repeat clinical diagnostic test	Use when the exact same antibody test is repeated on the same day to obtain a subsequent result or verify an unexpected result.
`59`	Distinct procedural service	Use when `86146` is billed on the same date as another unrelated lab procedure and documentation supports distinctness.
`90`	Reference (outside) laboratory	Use when an independent outside laboratory performs the technical testing (listed for clarity alongside `TC`).
`91`	Repeat clinical diagnostic test	Use when a repeat assay is clinically indicated on the same specimen or same day (listed for emphasis).
`90`	Reference (outside) laboratory	Use only once per billing; see payer rules for combining with `TC`/`26`.
`QW`	CLIA-waived test	Not typically applicable to `86146`; include only if specific waived methodology is used and payer accepts.

Taxonomy Code	Specialty	Notes
207R00000X	Clinical Laboratory	Laboratory medicine professionals who perform and oversee serologic testing.
2080P0006X	Pathology	Pathologists who interpret serologic and immunology test results.
207L00000X	Medical Laboratory Technologist/Technician	Medical technologists who perform the assay in the lab.
207LP2900X	Immunology	Clinical immunologists involved in test selection and interpretation.
2085R0202X	Rheumatology	Rheumatologists ordering antiphospholipid antibody panels in autoimmune disease evaluation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`O26.89`	Other specified pregnancy-related conditions	Pregnancy complications such as recurrent pregnancy loss where antiphospholipid antibodies, including beta-2 glycoprotein I, are evaluated.
`D68.59`	Other coagulation defects	Hypercoagulable conditions prompting antiphospholipid antibody testing as part of thrombophilia evaluation.
`D68.51`	Antiphospholipid syndrome	Direct indication for testing beta-2 glycoprotein I antibodies to confirm diagnosis.
`I82.90`	Acute embolism and thrombosis of unspecified vein	Venous thrombosis events leading to a workup that includes antiphospholipid antibody testing.
`I26.99`	Other pulmonary embolism without acute cor pulmonale	Pulmonary embolism cases where secondary causes including antiphospholipid antibodies are assessed.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`86147`	Beta-2 glycoprotein I antibody, IgM; laboratory analysis	Often ordered alongside `86146` (IgG) to assess both IgG and IgM isotypes when evaluating antiphospholipid antibodies.
`86431`	Antibody; rheumatoid factor, single determination	May be ordered in the broader autoimmune workup when rheumatologic disease is suspected; not specific but complementary in differential diagnosis.
`85610`	Prothrombin time, thromboplastin time, and INR	Common coagulation tests ordered concurrently when evaluating patients with thrombosis or anticoagulation needs.
`85301`	Protein C activity	Part of hypercoagulability panels that can be ordered in patients with thrombotic history alongside antiphospholipid antibody testing.
`36415`	Collection of venous blood by venipuncture	The specimen collection CPT typically performed prior to `86146` testing in outpatient or inpatient settings.