Summary & Overview
CPT 86308: Heterophile Antibody Screen for Infectious Mononucleosis
CPT code 86308 describes a serologic immunoassay used to screen serum or plasma for heterophile antibodies indicative of infectious mononucleosis. This widely used laboratory screening test supports initial diagnostic evaluation of patients with clinical signs consistent with mono and can influence subsequent confirmatory testing and clinical management. Nationally, accurate coding and consistent coverage policies for 86308 affect laboratory billing, claims processing, and epidemiologic tracking of mono diagnoses.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a compact overview of clinical context for the test, typical sites of service where it is performed, and the types of reimbursement and billing considerations commonly encountered across major payers. The report summarizes coverage patterns, allowed service settings, and common billing modifiers used with laboratory immunoassays where available. It also outlines how 86308 fits into diagnostic pathways for suspected infectious mononucleosis and what benchmarks and policy updates are most relevant for laboratory administrators and billing teams.
Data not available in the input for specific payer rates, ICD-10 pairings, and associated taxonomies.
Billing Code Overview
CPT code 86308 is an immunoassay performed on a patient’s serum or plasma to screen for heterophile antibodies commonly associated with infectious mononucleosis (IM). The test identifies antibodies that suggest recent or active Epstein-Barr virus–related mono and is used as a diagnostic screening tool in patients with compatible clinical symptoms.
Service type: Laboratory — serologic immunoassay screen
Typical site of service: Clinical laboratory or hospital outpatient laboratory
Clinical & Coding Specifications
Clinical Context
A 19-year-old college student presents to a primary care clinic with 2 weeks of sore throat, low-grade fever, fatigue, and posterior cervical lymphadenopathy. The clinician performs a focused history and exam, documents signs consistent with infectious mononucleosis vs streptococcal pharyngitis, and orders laboratory testing. The phlebotomy team collects a serum sample in the outpatient lab. The laboratory performs an immunoassay to detect heterophile antibodies consistent with infectious mononucleosis. Results are reported to the ordering provider; a positive 86308 supports a diagnosis of infectious mononucleosis and guides counseling for activity restriction and return-to-play decisions. Typical site of service is an outpatient clinic or outpatient laboratory collection center. The service type is an immunoassay/serologic screening test for heterophile antibodies (mono spot test).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the professional interpretation / reporting of the test separate from the lab technical component. |
TC | Technical component |