Summary & Overview
CPT 86603: Adenovirus Antibody Immunoassay
CPT code 86603 designates a laboratory immunoassay to detect antibodies to adenovirus in a patient specimen. As a serologic diagnostic test, it supports clinical assessment of suspected adenoviral infection and can inform infection control, treatment planning, and epidemiologic surveillance. Nationally, serology codes like 86603 matter for lab billing workflows, payer coverage determinations, and public health reporting when adenoviral testing is indicated.
Key payers in scope include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis addresses coding context, payer coverage patterns, and clinical usage considerations relevant to laboratories, hospital billing departments, and clinicians ordering infectious disease serology.
Readers will find benchmarks and coding guidance relevant to billing and claims submission, a concise description of clinical context for antibody testing to adenovirus, and a summary of common payer approaches and policy considerations. Where specific input data are missing, the publication notes that those data were not provided. The content is intended for a national audience working in laboratory services, medical billing, compliance, and clinical infectious disease management.
Billing Code Overview
CPT code 86603 describes an immunoassay performed by a laboratory analyst to evaluate a patient specimen for antibodies to adenovirus. This is a laboratory infectious disease serology test used to detect host immune response to adenoviral infection.
Service Type: Immunoassay / Serology
Typical Site of Service: Clinical laboratory or hospital laboratory performing diagnostic testing on patient specimens.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A patient presents to an outpatient clinic or hospital laboratory with symptoms of acute respiratory illness (fever, cough, conjunctivitis, or pharyngitis) or with a history suggesting recent exposure to adenovirus (e.g., outbreak in a congregate setting). A specimen (typically nasopharyngeal swab, throat swab, or conjunctival swab, or serum) is collected by nursing or clinic staff and sent to the clinical microbiology or immunology laboratory. The laboratory analyst performs an immunoassay to detect patient antibodies to adenovirus (CPT 86603). Results are used by the treating clinician to support diagnosis of recent or prior adenovirus infection, guide infection control measures, and inform further diagnostic testing (such as molecular PCR or viral culture) if clinically indicated. Typical site of service includes outpatient clinics, urgent care centers, hospital laboratories, and public health laboratories. Turnaround time is usually hours to a few days depending on laboratory workflow and testing volume.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing for the professional interpretation or reporting portion of the test separate from the technical component |
TC | Technical component | When billing only for the laboratory technical processing and materials |
90 | Reference (outside) laboratory | When the specimen is referred to an outside reference laboratory for testing |
59 | Distinct procedural service | When a separately identifiable laboratory service is performed on the same date that is distinct from other services |
91 | Repeat clinical diagnostic laboratory test | (Not in provided list) Data not available in the input |
52 | Reduced services | When the service is partially reduced or not performed as originally intended |
53 | Discontinued procedure | When testing is started but discontinued due to circumstances beyond the lab's control |
76 | Repeat procedure by same physician | (Not in provided list) Data not available in the input |
78 | Return to operating/procedure room by same physician following initial procedure for a related procedure during the postoperative period | Rarely applicable to lab testing; may be used when a procedure-related complication requires additional specimen collection |
90 | Reference (outside) laboratory | Duplicate entry removed; see above |
59 | Distinct procedural service | Duplicate entry removed; see above |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207T00000X | Infectious Disease | Physicians diagnosing and interpreting serologic testing for adenovirus |
| 207L00000X | Pathology | Pathologists who oversee clinical microbiology and immunology labs |
| 3353P2100X | Clinical Laboratory | Laboratory directors and clinical laboratory scientists performing immunoassays |
| 261QP0800X | Pediatrics | Pediatricians ordering adenovirus testing in children |
| 207RC0000X | Emergency Medicine | Emergency physicians ordering rapid adenovirus testing in acute presentations |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
| Data not available in the input | Data not available in the input | Data not available in the input |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
86603 | Immunoassay for antibodies to adenovirus; lab analyst performs immunoassay | Primary procedure described — detection of host antibody response to adenovirus |
87426 | Infectious agent antigen detection by immunoassay, adenovirus | Performed when direct antigen detection is needed for acute infection; may be ordered alongside or instead of antibody testing |
87506 | Infectious agent detection by nucleic acid (DNA or RNA); adenovirus; amplified probe technique | Molecular testing (PCR) often ordered when active infection is suspected and antibody testing is insufficient for acute diagnosis |
86631 | Immunoassay for antibodies to respiratory syncytial virus (RSV) | Other respiratory viral serologies that may be ordered in parallel in differential diagnosis |
87070 | Culture, bacterial, any source, screening only; may be used for ocular or respiratory cultures | Complementary microbiology studies when bacterial coinfection is a concern |
99000 | Handling and/or conveyance of specimen to outside laboratory (noncovered) | Administrative/transport codes used when specimens are sent to reference labs |