Summary & Overview
CPT 86406: Antibody Titer After Positive Agglutination Screening
CPT code 86406 represents a laboratory antibody titer assay performed to quantify a specific antibody after a positive particle agglutination screening test. This confirmatory and quantitative laboratory procedure is important for clinical decision-making in infectious disease management, immunology, and transfusion medicine. Nationally, accurate coding and billing for antibody titers affect lab reimbursement, clinical documentation, and downstream care coordination.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for using CPT code 86406, typical sites of service, common payer coverage considerations, and benchmarking themes. The publication outlines coding clarity, frequent billing scenarios, and how this service fits into laboratory workflows.
The report provides operational benchmarks where available, summaries of payer-specific coverage tendencies, and notes on documentation that supports medical necessity. Data not available in the input is identified explicitly. The content is designed for billing managers, laboratory directors, compliance officers, and clinicians who interface with laboratory billing and coding processes related to antibody titer testing.
Billing Code Overview
CPT code 86406 describes a titer test performed by a laboratory analyst to determine the concentration of a specific antibody in a specimen after a positive particle agglutination screening test. This service characterizes antibody levels to help confirm immune response or prior exposure following an initial reactive screening.
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Service type: Laboratory antibody titer assay
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Typical site of service: Clinical laboratory or hospital laboratory setting
Clinical & Coding Specifications
Clinical Context
A 32-year-old outpatient presents to the clinical laboratory after a reactive particle agglutination screening test for a specific infectious agent (for example, a serologic screen for a bacterial or viral antigen). The laboratory receives the serum specimen and performs a quantitative antibody titer to determine the concentration of the specific antibody responsible for the screening reactivity. The lab analyst documents specimen receipt, performs serial dilutions, incubates with antigen, reads agglutination endpoints, and reports the endpoint titer to the ordering clinician. Typical sites of service include hospital clinical laboratories, independent reference laboratories, and outpatient clinic laboratories where confirmatory serology is performed following a positive screening assay. The typical patient scenario is evaluation of suspected recent or past infection, assessment of immune status, or confirmation of screening test reactivity to guide diagnosis and management.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation/reporting portion if the laboratory separates professional and technical components. |
TC | Technical component |