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CPT 86703: HIV Antibody Immunoassay, Single Result
CPT code 86703 represents a laboratory immunoassay used to detect antibodies to HIV‑1 or HIV‑2 from a patient specimen, most commonly serum. As a frontline serologic test, this code is central to HIV screening and diagnosis workflows and informs public health reporting, clinical care pathways, and laboratory operations nationwide. The code is relevant for outpatient and inpatient laboratories, community testing sites, and public health settings.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise overview of clinical context for HIV antibody testing, comparisons to related assay codes, and typical sites of service. The publication provides benchmarks and payment considerations for CPT code 86703, notes common clinical indications, and summarizes coding relationships with confirmatory and antigen detection tests. Policy and billing updates that affect laboratory processing and payer coverage for immunoassays are outlined to help billing, compliance, and laboratory management teams understand reimbursement and coding interactions at a national level.
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Billing Code Overview
CPT code 86703 describes an immunoassay performed by a laboratory analyst to detect antibodies to human immunodeficiency virus (HIV) 1 or HIV 2 in a patient specimen, typically serum. This code applies to a single antibody result for either HIV‑1 or HIV‑2.
Service type: Laboratory diagnostic immunoassay
Typical site of service: Clinical laboratory or hospital laboratory
National Reimbursement Benchmarks
For CPT 86703 the national commercial average (BUCA) sits at $33.90, anchoring an overall market midpoint while individual payers display meaningful variation around that level. Blue Cross Blue Shield shows the highest central tendency with a mean of $49.60 and a median of $42.60, while Aetna and UnitedHealth Group center much lower near $11.80 and $12.00 mean rates respectively; Cigna’s mean is $14.80. BUCA provides a useful average commercial reference point at $33.90 without minimum or maximum bounds.
Dispersion measured by the interquartile range (P75–P25) highlights Blue Cross Blue Shield as relatively wide with a spread of $22.20, reflecting substantial variability in contracted rates, followed by Cigna at $11.80. UnitedHealth Group and BUCA are moderate with spreads of $7.70 and $15.60 respectively, while Aetna is the tightest with a spread of $5.00, indicating the least middle-range variability among these payers.