Summary & Overview
CPT 86617: Borrelia burgdorferi Antibody Immunoassay, Follow-Up
CPT code 86617 represents a lab immunoassay used to detect antibodies to Borrelia burgdorferi and is typically performed after an initial positive screening test for Lyme disease. This confirmatory serologic assay matters nationally because accurate laboratory confirmation guides clinical diagnosis, impacts public health reporting for tickborne disease surveillance, and influences payer coverage and utilization patterns for infectious disease testing.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for when CPT code 86617 is used, typical sites of service, and the role of this test in the diagnostic pathway for suspected Lyme disease. The publication also summarizes typical modifiers reported with laboratory services and highlights areas where national policy or coding guidance can affect billing and reimbursement workflows.
This content is written for a national audience and is intended to inform coding professionals, laboratory managers, and payer policy staff about the clinical and billing context of CPT code 86617. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 86617 describes an immunoassay performed by a laboratory analyst to detect antibodies to Borrelia burgdorferi, the bacterium that causes Lyme disease. This test is intended as a follow-up assay after an initial positive screening test to help confirm exposure to the organism.
Service Type: Laboratory diagnostic testing — serologic immunoassay
Typical Site of Service: Clinical laboratory or hospital laboratory
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Clinical & Coding Specifications
Clinical Context
A patient presents to an outpatient primary care or infectious disease clinic with a history of a tick bite and clinical features suspicious for Lyme disease, such as erythema migrans, fever, arthralgia, or neurologic symptoms. An initial screening test (typically an enzyme immunoassay or immunofluorescence assay) returns a positive or equivocal result. The clinician orders confirmatory serologic testing. In the laboratory, a clinical laboratory scientist or technologist performs an immunoassay specifically to detect IgM and/or IgG antibodies to Borrelia burgdorferi using the method documented under 86617. The typical site of service is an outpatient laboratory or hospital clinical laboratory. Specimen collection occurs in the clinic or phlebotomy area; the specimen (serum) is sent to the lab, processed, and the immunoassay is run, interpreted, and reported back to the ordering provider. Turnaround time varies from same day to several days depending on lab workflow and referral testing requirements. Results guide the clinician’s diagnostic confirmation and subsequent management decisions, including antibiotic therapy or specialist referral.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the professional component interpretation of the test separate from the technical component performed by the lab. |