Summary & Overview
CPT 86486: Skin Test for Delayed Type Hypersensitivity
CPT code 86486 represents a skin test for delayed type hypersensitivity (DTH) using an antigen not otherwise specified by other codes. DTH testing evaluates cell-mediated immune responses and helps identify prior sensitization to pathogens or antigens; it is a targeted diagnostic procedure commonly performed in allergy and immunology settings. Nationally, this code matters for accurate clinical documentation and claims processing where customized or non-standard antigens are used.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for DTH skin testing, guidance on typical sites of service, common billing modifiers associated with procedural services, and where available, national benchmarking and policy considerations relevant to payer coverage and claim adjudication. The publication summarizes typical use cases, coding nuances for tests using non-listed antigens, and operational implications for outpatient allergy and immunology practices. Data not available in the input for specific payor policies, ICD-10 pairings, associated taxonomies, and related codes.
Billing Code Overview
CPT code 86486 describes a skin test for delayed type hypersensitivity (DTH) using an antigen not listed in another code. The test assesses a cell-mediated inflammatory response that indicates a normal defense mechanism against pathogens.
Service type: Allergy/Immunology diagnostic testing — skin DTH antigen testing
Typical site of service: Outpatient clinic or allergy/immunology office, including specialty clinics where skin testing is performed. If performed as part of inpatient care, the service may occur in hospital outpatient departments or bedside in admitted settings.
Clinical & Coding Specifications
Clinical Context
A 28-year-old outpatient presents to an allergy clinic complaining of persistent localized skin induration after a suspected exposure to an environmental antigen. The clinician plans a delayed-type hypersensitivity (DTH) skin test using a custom antigen not listed under other specific skin test codes to evaluate cell-mediated immune response. The visit includes history review, informed consent, selection/preparation of the antigen, administration of intradermal or patch application, timed read(s) at 48–72 hours, documentation of induration/erythema measurements, and interpretation by the performing clinician. Typical staff involved include an allergist or immunologist (or trained technician under supervision), nursing staff to place and measure the test, and a clinical analyst or laboratory technologist preparing and labeling the unlisted antigen. The procedure is commonly performed in an outpatient clinic, allergy/immunology office, or hospital outpatient department. Billing uses 86486 for the analyst-performed DTH skin test with an antigen not listed elsewhere; modifier use depends on professional component, unusual circumstances, or payer requirements. Common payors for process workflows include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing physician/clinician interpretation separate from technical performance. |