Summary & Overview
CPT 86612: Blastomyces Antibody Immunoassay
CPT code 86612 represents a laboratory immunoassay for detection of antibodies to Blastomyces, a fungal pathogen that can cause systemic infection. As a specific serologic test, it supports clinical diagnosis when blastomycosis is suspected and can guide further diagnostic and treatment decisions. Nationally, accurate coding and billing for such specialized infectious disease assays matters for lab reimbursement, clinical workflows, and public health surveillance.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the assay, typical sites of service, common billing considerations, and national payer coverage patterns where available. The publication summarizes benchmarks and utilization context for CPT code 86612, highlights relevant policy and coding notes that affect reimbursement and claim adjudication, and outlines what clinical teams and billing staff need to document when ordering or processing this test.
Data not available in the input: associated taxonomies, specific ICD-10 diagnoses, related codes, and detailed payer-specific rate tables.
Billing Code Overview
CPT code 86612 describes an immunoassay performed by a laboratory analyst to detect antibodies to the fungus Blastomyces in a patient’s blood. This test is a serologic diagnostic assay used to support evaluation for blastomycosis, a systemic fungal infection.
Service type: Laboratory — serologic immunoassay
Typical site of service: Clinical laboratory or hospital laboratory, including reference labs and inpatient or outpatient hospital lab settings.
Clinical & Coding Specifications
Clinical Context
A patient presents to an outpatient infectious disease clinic or hospital laboratory with progressive respiratory symptoms (cough, fever, chest pain) and a history of travel or residence in areas endemic for Blastomyces (e.g., Mississippi and Ohio River valleys, Great Lakes region). Initial evaluation includes history, physical exam, chest radiography, and routine microbiology. When fungal infection is suspected, the clinician orders serologic testing for Blastomyces antibodies to support diagnosis. A phlebotomy technician draws a blood specimen which is sent to the clinical laboratory. A medical laboratory scientist performs an immunoassay to detect patient antibodies to Blastomyces; results are reviewed and reported in the electronic medical record. Results guide subsequent management such as antifungal therapy initiation, further fungal culture, histopathology or antigen testing, and infectious disease consultation. Typical sites of service are outpatient clinics, hospital inpatient wards, emergency departments, and independent clinical laboratories performing infectious disease serology.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing separately for the laboratory professional interpretation component if applicable in mixed technical/professional arrangements |
59 |