Summary & Overview
CPT 86160: Complement Antigen Assay, Laboratory Technical Test
CPT code 86160 identifies a laboratory test that measures complement antigens (C1–C9), key proteins in the immune system used to detect infection and evaluate autoimmune disorders. Nationally, complement testing plays a role in diagnostic workups for suspected complement-mediated disease, monitoring immune status, and guiding specialist evaluation.
This analysis covers major national payers: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for complement antigen measurement, common sites and workflows where the technical component is performed, and the payer landscape relevant to laboratory reimbursement and coverage. The publication presents benchmarks where available, notes policy and coding considerations, and summarizes typical clinical indications for ordering complement antigen assays.
The audience will gain concise guidance on the clinical purpose of CPT code 86160, expected settings of service, and the payer mix addressed in the analysis. Data not provided in the input (for example, specific coverage policies, fee schedules, or associated ICD-10 codes) are noted as unavailable where applicable.
Billing Code Overview
CPT code 86160 describes a laboratory technical test measuring levels of complement antigens (components such as C1 through C9). These complement proteins are important in detecting and fighting infection and in evaluating autoimmune conditions and diseases that produce antibodies against the body’s own cells and tissues.
Service Type: Clinical laboratory testing — complement antigen assay (technical component)
Typical Site of Service: Clinical laboratory or hospital laboratory performing serologic or immunologic testing.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical adult patient presents to an outpatient rheumatology clinic with new onset inflammatory arthritis, unexplained recurrent infections, or signs of systemic lupus erythematosus (SLE). The ordering provider documents clinical concern for complement pathway dysfunction to evaluate levels of complement proteins (C1–C9) as part of autoimmune workup or immunodeficiency assessment. A phlebotomy draw is performed in the clinic or same-day laboratory; the specimen is sent to the clinical laboratory for the technical assay measuring complement antigen levels. The laboratory analyst performs the assay (technical component) and reports results to the ordering clinician, who integrates findings with serologies (for example ANA, anti-dsDNA), inflammatory markers, and clinical exam to guide diagnosis and management. Typical workflow sites include outpatient clinic laboratories, hospital inpatient laboratories, and reference/central labs that receive couriered specimens from ambulatory sites.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting the physician interpretation component separate from the lab's technical test (rare for this lab-only CPT). |
TC | Technical component |