Summary & Overview
CPT 86162: Total Hemolytic Complement (CH50) Assay
CPT code 86162 represents the laboratory measurement of total hemolytic complement activity (CH50), a clinical immunology assay used to detect deficiencies in the complement cascade. Nationally, CH50 testing is an important diagnostic tool in immunology and nephrology, helping identify patients with complement-mediated disorders and guiding downstream specialized testing.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines how CPT code 86162 is billed across typical laboratory settings and summarizes payer coverage patterns and common billing modifiers. Readers will find: benchmarks for typical sites of service and clinical use cases, an explanation of the clinical context for CH50 testing, and summaries of documentation and coding considerations relevant to laboratory and hospital billing workflows.
The content is intended for a national audience of laboratory directors, coding and billing professionals, and compliance officers who need a concise reference on the clinical meaning of CPT code 86162, its service context, and the types of payers that typically cover the assay. Data not available in the input will be noted where relevant.
Billing Code Overview
CPT code 86162 describes a laboratory test measuring total hemolytic complement (CH50). The procedure quantifies overall complement system activity to detect complement deficiencies; the result indicates reduced or absent total complement function but does not identify the specific deficient complement component.
Service Type: Clinical laboratory service — quantitative immunology assay
Typical Site of Service: Clinical laboratory or hospital laboratory
Clinical & Coding Specifications
Clinical Context
A 28-year-old patient presents to the immunology clinic with recurrent, severe infections and unexplained autoimmune features. The ordering clinician requests measurement of total hemolytic complement to assess the integrity of the classical complement cascade. Blood is drawn in the outpatient laboratory; the specimen is transported to the lab service where a licensed medical technologist performs the 86162 technical assay (CH50). Results are reviewed by the laboratory director and the ordering immunologist. If CH50 is markedly reduced or absent, reflex testing for specific complement component levels (for example C3, C4, or individual component assays) or functional alternative pathway testing may be ordered. Typical sites of service include hospital outpatient laboratories, independent clinical laboratories, and large academic medical center laboratories. The service type is a laboratory/diagnostic biochemical test performed by trained laboratory personnel with reporting to the ordering provider.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional (interpretive) component and technical component is billed separately. |
TC |