Summary & Overview
CPT 86581: Streptococcus pneumoniae Quantitative Multiplex Antibody Assay
CPT code 86581 represents a laboratory-performed, quantitative multiplex immunoassay for detection of Streptococcus pneumoniae antibodies, reported by serotype. The code captures serologic evaluation used in clinical assessment of immune response to pneumococcal exposure or vaccination and has relevance for infectious disease management, vaccine response monitoring, and epidemiologic surveillance. Nationally, such serotype-specific testing informs clinical decisions in immunocompromised patients and supports public health efforts to track serotype prevalence.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for serotype-specific pneumococcal antibody testing, typical sites of service, commonly used modifiers, and payers' coverage considerations where available. The publication outlines benchmarks and utilization context when data is present and notes where information is not available in the input.
This summary provides clinicians, laboratory managers, and billing professionals with a concise reference to CPT code 86581, clarifying the service captured by the code and the primary clinical scenarios in which quantitative multiplex pneumococcal serology is used.
Billing Code Overview
CPT code 86581 reports a quantitative multiplex immunoassay performed by a laboratory analyst to evaluate the presence of Streptococcus pneumoniae antibodies in a patient specimen. The test measures antibody levels against multiple S. pneumoniae serotypes and provides serotype-specific quantitative results.
Service type: Laboratory — immunology/serology, multiplex quantitative assay
Typical site of service: Clinical laboratory or hospital laboratory
Clinical & Coding Specifications
Clinical Context
A patient aged 65 with a history of recurrent community-acquired pneumonia presents for immunologic evaluation after an unusual or severe pneumococcal infection. The clinician orders serotype-specific quantitative pneumococcal antibody testing to assess humoral immunity to Streptococcus pneumoniae. Blood is collected in an outpatient clinic or hospital phlebotomy lab and sent to a clinical laboratory that performs multiplex immunoassay panels to measure IgG antibody concentrations against multiple pneumococcal serotypes. The lab analyst runs the multiplex immunoassay, quantifies serotype-specific antibody levels, interprets results against protective thresholds, and reports findings to the ordering physician. Typical workflow steps include: specimen collection and labeling, accessioning, specimen preparation, running the multiplex immunoassay on automated analyzers, quality control, result verification by a clinical laboratory scientist, and result reporting to the ordering provider for clinical correlation and next-step management decisions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing for physician or laboratorian interpretation separate from the technical test performance, if applicable. |
52 |