Summary & Overview
CPT 86310: Heterophile Antibody Immunoassay for Infectious Mononucleosis
CPT code 86310 captures an immunoassay performed on serum or plasma to titer heterophile antibodies after absorption with beef cells and guinea pig kidney, a serologic test commonly used in diagnosing infectious mononucleosis. This laboratory procedure remains clinically relevant for acute presentations of sore throat, lymphadenopathy, and systemic symptoms where rapid serologic confirmation of mono influences patient management and infection control.
Key payers in the national landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of the clinical context for CPT code 86310, typical sites of service where the test is billed, and an overview of common modifiers and billing considerations. The publication outlines benchmarking and reimbursement context where available, highlights coding and billing nuances specific to laboratory immunoassays, and summarizes implications for laboratory operations and payer interactions.
This summary is intended for a national audience of billing managers, laboratory directors, and policy analysts seeking a practical briefing on CPT code 86310, its clinical use in diagnosing infectious mononucleosis, and the billing considerations that commonly arise in payer contracts and claims processing.
Billing Code Overview
CPT code 86310 describes an immunoassay for heterophile antibodies performed on a patient’s serum or plasma after absorption with beef cells and guinea pig kidney. The test determines antibody titers associated with infectious mononucleosis (IM) and is a serologic diagnostic procedure used to detect heterophile antibodies consistent with mono.
Service Type
- Laboratory diagnostic test (immunoassay)
Typical Site of Service
- Clinical laboratory or hospital laboratory
- Outpatient laboratory draw sites
Clinical & Coding Specifications
Clinical Context
A 19-year-old college student presents to an urgent care clinic with 10 days of fever, sore throat, fatigue, and posterior cervical lymphadenopathy. The primary care clinician performs a history and physical, orders a rapid streptococcal test (negative) and a point-of-care monospot screen. The monospot is reactive, and a serum sample is sent to the laboratory for confirmatory heterophile antibody titer by immunoassay consistent with 86310. The laboratory analyst performs the heterophile antibody immunoassay after absorption with beef red cells and guinea pig kidney to reduce false positives. Results are reported to the ordering clinician via the electronic medical record and interpreted in the context of other tests (complete blood count with atypical lymphocytes, liver function tests). Typical sites of service include hospital outpatient laboratories, independent clinical laboratories, and ambulatory care urgent care clinics with send-out testing. The clinical workflow includes specimen collection (serum or plasma), specimen labeling and transport to the lab, performance of the immunoassay by trained laboratory personnel, result validation, and electronic reporting to the ordering provider for clinical correlation and patient counseling.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (default) | Use when no special reporting modifier applies. |