Summary & Overview
CPT 86280: Hemagglutination Inhibition (HAI) Antibody Immunoassay
CPT code 86280 describes a laboratory immunoassay using the hemagglutination inhibition (HAI) method to detect antibodies to a specific antigen in a patient’s blood sample. This assay is important for diagnosing and monitoring immune responses in infectious diseases and vaccine evaluation. Nationally, accurate coding for specialized serologic tests like HAI matters for clinical interpretation, laboratory workflow, and payer coverage decisions.
Key payers covered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical purpose of the HAI immunoassay, typical sites of service, common billing modifiers associated with laboratory services, and which payers commonly cover similar serologic testing. The publication provides benchmarks on reimbursement patterns, coding guidance context, and policy updates relevant to lab reimbursement and claims processing.
This summary equips laboratory managers, billing professionals, and policy analysts with the clinical context and payer landscape for CPT code 86280, clarifying where the test is performed and why precise coding and documentation matter for claim adjudication and public health reporting.
Billing Code Overview
CPT code 86280 describes an immunoassay using hemagglutination inhibition (HAI) performed by a laboratory analyst to evaluate a patient’s blood sample for antibodies to a specific antigen. The procedure assesses serologic response and is commonly used in infectious disease and immunology testing.
Service Type: Laboratory immunoassay (hemagglutination inhibition test)
Typical Site of Service: Clinical laboratory or hospital laboratory
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Clinical & Coding Specifications
Clinical Context
A typical clinical scenario involves an adult or pediatric patient with suspected recent or prior infection or vaccination exposure where antibody titers to specific viral or bacterial antigens are needed. A clinician orders a hemagglutination inhibition (HAI) assay to assess serum antibody levels, commonly for influenza serology or other viruses that agglutinate red blood cells. The patient presents to an outpatient laboratory, hospital lab, or public health clinic; a phlebotomist obtains a blood specimen which is sent to the immunology/serology laboratory. The laboratory analyst performs the 86280 HAI immunoassay, records dilution titers, interprets agglutination endpoints, and reports results to the ordering provider. Typical workflow steps: specimen collection and labeling, accessioning, serum separation and storage, performance of serial dilutions and antigen incubation, reading of hemagglutination inhibition endpoints, quality controls and documentation, and result reporting to the medical record and ordering clinician. Typical sites of service are outpatient laboratory, hospital laboratory, public health laboratory, and reference laboratory facilities. Patient indications include evaluation of immune response after vaccination, confirmation of recent or past infection (for example suspected influenza exposure), epidemiologic surveillance, or pre-transplant infectious disease assessment when specific antibody status is relevant.
Coding Specifications
| Modifier | Description | When to Use |
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