Summary & Overview
CPT 86628: Candida Antibody Immunoassay
CPT code 86628 designates a laboratory immunoassay that detects antibodies to Candida species in a patient’s blood. This code is used to report serologic testing relevant to suspected fungal infection or immune response monitoring. Nationally, antibody testing for Candida is a component of diagnostic workflows in immunocompromised patients and in settings where fungal exposure or invasive candidiasis is a concern.
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 serologic Candida testing, typical sites of service, common billing modifiers, and how 86628 is positioned within laboratory service lines. The publication provides benchmarks and coding guidance where available, explains payer coverage patterns, and summarizes relevant policy updates that affect laboratory billing and documentation for fungal antibody testing.
This summary equips coding professionals, laboratory managers, and billing staff with concise context about when CPT code 86628 is used, what clinical scenarios it supports, and which national payers commonly appear in coverage discussions.
Billing Code Overview
CPT code 86628 describes an immunoassay performed by a laboratory analyst to detect antibodies to the fungus Candida in a patient’s blood. The service involves laboratory testing to evaluate host immune response to Candida species rather than direct identification of the organism.
Service type: Laboratory immunoassay
Typical site of service: Clinical laboratory or hospital laboratory setting
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to primary care or an infectious disease clinic with symptoms suggestive of systemic or recurrent mucocutaneous candidiasis such as persistent oral thrush, esophagitis, chronic vaginitis, or unexplained fever in an immunocompromised patient. The clinician orders a serologic immunoassay to detect antibodies to Candida to support diagnosis, evaluate prior exposure, or help differentiate colonization from invasive disease in conjunction with culture, antigen testing, and clinical findings. Blood is drawn in an outpatient laboratory, sent to the clinical laboratory where a medical technologist or laboratory analyst performs the immunoassay (CPT 86628). Results are reviewed by the ordering clinician and integrated with other diagnostic studies (e.g., blood cultures, beta-D-glucan, imaging) to guide management. Typical sites of service include outpatient laboratories, hospital inpatient laboratories, and clinic-based phlebotomy settings. Modifiers may be applied when professional/technical components, unusual circumstances, or payer-specific billing rules require distinction.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing for the physician or pathologist's interpretation/reporting of the test separate from the lab technical component |