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CPT 86696: Immunoassay for HSV-2 Antibodies in Serum or CSF

CPT code 86696 covers a laboratory immunoassay that detects antibodies to herpes simplex virus type 2 (HSV-2) in serum or cerebrospinal fluid. This diagnostic test is clinically important for identifying prior HSV-2 exposure, aiding in the evaluation of genital or neurologic herpes infections, and guiding further clinical and public health decisions. Nationally, antibody testing for HSV-2 is a routine component of infectious disease diagnostics and public health surveillance.

Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis focuses on coverage patterns, common billing practices, and clinical context relevant to laboratory and hospital settings. Readers will find concise benchmarks for how this service is positioned across major payers, a summary of clinical indications and specimen types, and an explanation of the service line and typical sites of service where 86696 is billed. Where specific data elements were not supplied in the input, the document notes: "Data not available in the input." This publication is intended to provide a practical, national-level reference for coding, billing, and clinical teams handling HSV-2 antibody immunoassays.

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Billing Code Overview

CPT code 86696 describes an immunoassay performed by a laboratory analyst to detect antibodies to herpes simplex virus type 2 (HSV-2) in a patient's serum or cerebrospinal fluid (CSF). This test identifies the presence of HSV-2–specific antibodies to help determine prior exposure or immune response to HSV-2.

Service Type: Laboratory diagnostic immunoassay

Typical Site of Service: Clinical laboratory or hospital laboratory (inpatient or outpatient), and specimens are submitted from ambulatory clinics, emergency departments, or inpatient wards for serum or CSF testing.

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CPT 86696: Immunoassay for HSV-2 Antibodies in Serum or CSF

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Billing Code Overview

Service Type: Laboratory diagnostic immunoassay

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult presenting to an outpatient clinic or emergency department with genital vesicular lesions, dysuria, fever, or meningitis/aseptic encephalitis symptoms. A clinician collects blood (serum) or cerebrospinal fluid (CSF) and orders laboratory testing for herpes simplex virus type 2 (HSV-2) antibodies to differentiate primary versus recurrent infection or to support a diagnosis of HSV-2–associated central nervous system infection. The sample is sent to a clinical laboratory where a medical technologist or lab analyst performs an immunoassay (enzyme immunoassay or chemiluminescent immunoassay) to detect HSV-2–specific IgG and/or IgM antibodies. Results are reviewed by the laboratory and reported to the ordering provider; positive serology supports prior exposure or recent infection depending on antibody class and clinical context, while CSF antibody detection can support CNS involvement. Typical sites of service include hospital inpatient laboratories, outpatient hospital laboratories, independent clinical reference laboratories, and emergency department specimen processing labs.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the professional (interpretive) component of the test if the laboratory separates technical and professional components.
`TC`	Technical component	Use when billing only the technical component (laboratory processing) of the test.
`91`	Repeat clinical diagnostic laboratory test	Use when the same laboratory test is repeated on a subsequent sample to confirm results or monitor seroconversion.
`59`	Distinct procedural service	Use when this test is clinically distinct from other tests billed the same day and needs to be identified as separate.
`90`	Reference (outside) laboratory	Use when the specimen is sent to an outside reference lab for testing.
`90` is CMS-standardized and sometimes payer-specific; use according to payer guidance.
`52`	Reduced services	Use when the lab performs a reduced or partial version of the assay.
`53`	Discontinued procedure	Use if specimen collection or testing was started but discontinued for documented clinical reasons.
`59`	Distinct procedural service	Use to indicate a separate test when multiple lab procedures are billed that might be bundled.
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	Rarely applicable; use only if professional interpretation was provided via telemedicine consistent with payer rules.
`QW`	CLIA waived test	Use when the performed test is CLIA-waived (not typical for HSV-2 immunoassays which are usually moderate complexity).
`GZ`	Item or service expected to be denied as not reasonable and necessary	Use when providing documentation that the service was provided but no advanced medical review determination exists.
`GA`	Waiver of liability statement on file (ABN)	Use when an Advance Beneficiary Notice is on file and the beneficiary may be billed if Medicare denies.
`CR`	Catastrophe/disaster related	Use when testing is performed related to a declared disaster affecting billing rules.

Taxonomy Code	Specialty	Notes
207Q00000X	Infectious Disease	Infectious disease physicians order and interpret HSV testing in complex cases.
207L00000X	Emergency Medicine	Emergency physicians commonly order HSV-2 testing for acute presentations.
2080P0003X	Pathology & Laboratory Medicine	Pathologists and laboratory directors oversee assay validation and result interpretation.
207K00000X	Family Medicine	Primary care and family physicians order HSV serology in outpatient settings.
207RC0000X	Obstetrics & Gynecology	OB/GYN providers order HSV testing in pregnancy or genital lesion evaluation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`A60.0`	Anogenital herpesviral [herpes simplex] infection	Direct indication for HSV-2 serology in evaluation of genital lesions.
`A60.9`	Herpesviral infection, unspecified	Used when herpes infection is suspected but type not yet specified; serology helps type determination.
`B00.2`	Herpesviral meningitis	CSF HSV testing and serology are relevant for diagnosing HSV-related CNS infection.
`B00.9`	Herpesviral infection, unspecified	General code for suspected herpes infection where HSV-2 testing may be ordered.
`O98.8XX0`	Other infectious and parasitic diseases complicating pregnancy, unspecified trimester	HSV testing in pregnancy when maternal infection or exposure is a concern.
`R11.0`	Nausea with vomiting	Symptom code that may accompany systemic viral infection prompting broader infectious workup including HSV-2 testing.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`86696`	Antibody; herpes simplex virus type 2 (HSV-2) (e.g., immunoassay)	Primary laboratory immunoassay used to detect HSV-2 antibodies in serum or CSF.
`87205`	Smear, primary source with interpretation; fluorescent antibody, direct technique	May be used for direct fluorescent antibody testing of lesion exudate when evaluating active mucocutaneous lesions.
`87804`	Infectious agent antigen detection by immunoassay technique, multiple-step method; viral antigens (e.g., from lesion swab)	Used for antigen detection from lesion swabs to detect active HSV infection when rapid antigen methods are employed.
`87491`	Infectious agent detection by nucleic acid (DNA or RNA); HSV-1, HSV-2, multiplex, amplified probe technique, each organism	Molecular PCR testing of lesion swabs or CSF for HSV DNA provides direct evidence of active infection and is commonly ordered alongside serology for acute presentations.
`87070`	Culture, bacterial; any other source except urine, blood or stool, with isolation and presumptive identification of isolates	Viral culture of lesions is less common now but may be billed when culture is performed in addition to immunoassay.
`82677`	Antibody; herpes simplex virus, IgM	Complementary serologic testing for HSV-specific IgM when assessing recent/primary infection; often reported alongside IgG testing.

86803 – Qualitative or Semiquantitative Immunoassays; Hepatitis C antibody

CPT-86000-FEBRILE-AGGLUTININS-SEROLOGIC-TEST

CPT 86000: Serologic Test for Febrile Agglutinins

CPT-86001-ALLERGEN-SPECIFIC-IGG-LABORATORY-TEST

CPT 86001: Allergen-specific Immunoglobulin G (IgG) Test

CPT-86003-ALLERGEN-SPECIFIC-IGE-ASSAY-TECHNICAL

CPT 86003: Allergen-Specific IgE Assay, Technical Component

CPT-86005-MULTI-ALLERGEN-IGE-SCREENING-QUALITATIVE

CPT 86005: Multi-Allergen IgE Screening, Qualitative

CPT-86008-ALLERGEN-COMPONENT-SPECIFIC-IGE-ASSAY

CPT 86008: Allergen Component-Specific IgE Assay

CPT-86015-ANTI-ACTIN-SMOOTH-MUSCLE-ANTIBODY-ASMA

CPT 86015: Anti‑Actin (Smooth Muscle) Antibody (ASMA) Test

CPT-86021-LEUKOCYTE-ANTIBODY-IDENTIFICATION-LAB-TECHNICAL

CPT 86021: Leukocyte Antibody Identification, Technical Laboratory Service

CPT-86022-PLATELET-ANTIBODY-IDENTIFICATION-TECHNICAL-TEST

CPT 86022: Platelet Antibody Identification, Technical Component

CPT-86023-PLATELET-ASSOCIATED-IMMUNOGLOBULIN-DETECTION

CPT 86023: Platelet-Associated Immunoglobulin Detection

Showing 1–10 of 199

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the professional (interpretive) component of the test if the laboratory separates technical and professional components.
`TC`	Technical component	Use when billing only the technical component (laboratory processing) of the test.
`91`	Repeat clinical diagnostic laboratory test	Use when the same laboratory test is repeated on a subsequent sample to confirm results or monitor seroconversion.
`59`	Distinct procedural service	Use when this test is clinically distinct from other tests billed the same day and needs to be identified as separate.
`90`	Reference (outside) laboratory	Use when the specimen is sent to an outside reference lab for testing.
`90` is CMS-standardized and sometimes payer-specific; use according to payer guidance.
`52`	Reduced services	Use when the lab performs a reduced or partial version of the assay.
`53`	Discontinued procedure	Use if specimen collection or testing was started but discontinued for documented clinical reasons.
`59`	Distinct procedural service	Use to indicate a separate test when multiple lab procedures are billed that might be bundled.
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	Rarely applicable; use only if professional interpretation was provided via telemedicine consistent with payer rules.
`QW`	CLIA waived test	Use when the performed test is CLIA-waived (not typical for HSV-2 immunoassays which are usually moderate complexity).
`GZ`	Item or service expected to be denied as not reasonable and necessary	Use when providing documentation that the service was provided but no advanced medical review determination exists.
`GA`	Waiver of liability statement on file (ABN)	Use when an Advance Beneficiary Notice is on file and the beneficiary may be billed if Medicare denies.
`CR`	Catastrophe/disaster related	Use when testing is performed related to a declared disaster affecting billing rules.

Taxonomy Code	Specialty	Notes
207Q00000X	Infectious Disease	Infectious disease physicians order and interpret HSV testing in complex cases.
207L00000X	Emergency Medicine	Emergency physicians commonly order HSV-2 testing for acute presentations.
2080P0003X	Pathology & Laboratory Medicine	Pathologists and laboratory directors oversee assay validation and result interpretation.
207K00000X	Family Medicine	Primary care and family physicians order HSV serology in outpatient settings.
207RC0000X	Obstetrics & Gynecology	OB/GYN providers order HSV testing in pregnancy or genital lesion evaluation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`A60.0`	Anogenital herpesviral [herpes simplex] infection	Direct indication for HSV-2 serology in evaluation of genital lesions.
`A60.9`	Herpesviral infection, unspecified	Used when herpes infection is suspected but type not yet specified; serology helps type determination.
`B00.2`	Herpesviral meningitis	CSF HSV testing and serology are relevant for diagnosing HSV-related CNS infection.
`B00.9`	Herpesviral infection, unspecified	General code for suspected herpes infection where HSV-2 testing may be ordered.
`O98.8XX0`	Other infectious and parasitic diseases complicating pregnancy, unspecified trimester	HSV testing in pregnancy when maternal infection or exposure is a concern.
`R11.0`	Nausea with vomiting	Symptom code that may accompany systemic viral infection prompting broader infectious workup including HSV-2 testing.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`86696`	Antibody; herpes simplex virus type 2 (HSV-2) (e.g., immunoassay)	Primary laboratory immunoassay used to detect HSV-2 antibodies in serum or CSF.
`87205`	Smear, primary source with interpretation; fluorescent antibody, direct technique	May be used for direct fluorescent antibody testing of lesion exudate when evaluating active mucocutaneous lesions.
`87804`	Infectious agent antigen detection by immunoassay technique, multiple-step method; viral antigens (e.g., from lesion swab)	Used for antigen detection from lesion swabs to detect active HSV infection when rapid antigen methods are employed.
`87491`	Infectious agent detection by nucleic acid (DNA or RNA); HSV-1, HSV-2, multiplex, amplified probe technique, each organism	Molecular PCR testing of lesion swabs or CSF for HSV DNA provides direct evidence of active infection and is commonly ordered alongside serology for acute presentations.
`87070`	Culture, bacterial; any other source except urine, blood or stool, with isolation and presumptive identification of isolates	Viral culture of lesions is less common now but may be billed when culture is performed in addition to immunoassay.
`82677`	Antibody; herpes simplex virus, IgM	Complementary serologic testing for HSV-specific IgM when assessing recent/primary infection; often reported alongside IgG testing.

86803 – Qualitative or Semiquantitative Immunoassays; Hepatitis C antibody

CPT-86000-FEBRILE-AGGLUTININS-SEROLOGIC-TEST

CPT 86000: Serologic Test for Febrile Agglutinins

CPT-86001-ALLERGEN-SPECIFIC-IGG-LABORATORY-TEST

CPT 86001: Allergen-specific Immunoglobulin G (IgG) Test

CPT-86003-ALLERGEN-SPECIFIC-IGE-ASSAY-TECHNICAL

CPT 86003: Allergen-Specific IgE Assay, Technical Component

CPT-86005-MULTI-ALLERGEN-IGE-SCREENING-QUALITATIVE

CPT 86005: Multi-Allergen IgE Screening, Qualitative

CPT-86008-ALLERGEN-COMPONENT-SPECIFIC-IGE-ASSAY

CPT 86008: Allergen Component-Specific IgE Assay

CPT-86015-ANTI-ACTIN-SMOOTH-MUSCLE-ANTIBODY-ASMA

CPT 86015: Anti‑Actin (Smooth Muscle) Antibody (ASMA) Test

CPT-86021-LEUKOCYTE-ANTIBODY-IDENTIFICATION-LAB-TECHNICAL

CPT 86021: Leukocyte Antibody Identification, Technical Laboratory Service

CPT-86022-PLATELET-ANTIBODY-IDENTIFICATION-TECHNICAL-TEST

CPT 86022: Platelet Antibody Identification, Technical Component

CPT-86023-PLATELET-ASSOCIATED-IMMUNOGLOBULIN-DETECTION

CPT 86023: Platelet-Associated Immunoglobulin Detection

Showing 1–10 of 199

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 86696: Immunoassay for HSV-2 Antibodies in Serum or CSF

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Billing Code Overview

OpenPayer

CPT 86696: Immunoassay for HSV-2 Antibodies in Serum or CSF

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 86696: Immunoassay for HSV-2 Antibodies in Serum or CSF

Sign up for cpt 86696 policy alerts

Billing Code Overview

CPT 86696: Immunoassay for HSV-2 Antibodies in Serum or CSF

Sign up for cpt 86696 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 86696 represent and when is it used?

Where is the HSV-2 immunoassay (86696) typically performed and what specimen types are used?

Which CPT modifiers are relevant for billing 86696 and when might they be applied?

What related CPT codes or tests are commonly associated with HSV-2 antibody immunoassay?

Does the page provide reimbursement rates or payer-specific coverage rules for CPT 86696?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does CPT 86696 represent and when is it used?

Where is the HSV-2 immunoassay (86696) typically performed and what specimen types are used?

Which CPT modifiers are relevant for billing 86696 and when might they be applied?

What related CPT codes or tests are commonly associated with HSV-2 antibody immunoassay?

Does the page provide reimbursement rates or payer-specific coverage rules for CPT 86696?

References