CPT 86701: HIV-1 Antibody Immunoassay on Serum
Commercial payers pay $24 on average nationally for this procedure.
CPT code 86701 describes a laboratory immunoassay performed on a patient’s serum to detect antibodies to human immunodeficiency virus 1 (HIV‑1); this is a diagnostic infectious disease serology test typically processed in a clinical laboratory and ordered for patients with possible exposure, symptoms suggestive of acute or chronic HIV infection, or for screening purposes.
For related coverage guidance, see recent payer policy updates: Diagnosis of Idiopathic Environmental Intolerance, Allergen Testing, Allergen Testing.
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National Reimbursement Benchmarks
Commercial reimbursement for CPT 86701 centers on a BUCA average of $24.4, with individual payers showing meaningful differences in both central tendency and spread. Blue Cross Blue Shield has the highest median ($28.7) and a wide interquartile spread ($43.10 - $22.70 = $20.40), reflecting substantial variability in negotiated rates; Cigna and Aetna cluster lower around their medians ($8.1 and $7.0 respectively) with Cigna’s IQR of $12.60 - $5.00 = $7.60 and Aetna’s IQR of $8.40 - $5.20 = $3.20, indicating Aetna is relatively tighter among those two.
UnitedHealth Group shows moderate central tendency (median $5.30) with an IQR of $8.90 - $4.00 = $4.90, placing its dispersion between Aetna’s tighter band and Blue Cross Blue Shield’s wide band. Overall, Blue Cross Blue Shield exhibits the widest IQR ($20.40) and Aetna the tightest ($3.20), with BUCA serving as the mid-market average at $24.4.