Summary & Overview
CPT 86705: Hepatitis B Core IgM Antibody Immunoassay
CPT code 86705 represents a laboratory immunoassay to detect immunoglobulin M (IgM) antibody to hepatitis B core antigen, a marker commonly used to identify recent or acute hepatitis B infection. Nationally, this test is clinically important for early diagnosis, public health surveillance, and management decisions in acute hepatitis B cases. It is performed by clinical or hospital laboratories on serum specimens and informs timely clinical and epidemiologic responses.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical context, typical sites of service, and payer coverage scope. The publication outlines common billing modifiers associated with laboratory services, describes expected service settings, and summarizes areas where policy changes or payer edits may affect claim adjudication. Benchmarks and reimbursement trends are discussed where available; when specific data points are not provided in the input, the text indicates that data is not available.
This summary is intended for national audiences including laboratory managers, billing professionals, and policy analysts seeking a clear reference on the clinical purpose and billing context of CPT code 86705.
Billing Code Overview
CPT code 86705 describes an immunoassay performed by a laboratory analyst to detect immunoglobulin M (IgM) antibody to hepatitis B core antigen (anti-HBc IgM) in a patient specimen, typically serum. This test is used to evaluate recent or acute hepatitis B virus infection.
Service type: Laboratory diagnostic immunoassay
Typical site of service: Clinical laboratory or hospital laboratory
Data not available in the input for associated taxonomies, specific ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A 32-year-old outpatient presents to a primary care clinic for evaluation after a recent needlestick exposure at work. The patient has no known history of hepatitis B vaccination or prior hepatitis B infection. A serum sample is collected and sent to the clinical laboratory for serologic testing, including an immunoassay to detect hepatitis B core IgM antibody to evaluate for acute or recent hepatitis B virus (HBV) infection. The laboratory analyst performs 86705 on the serum specimen. Typical workflow steps include: patient encounter and order entry by the clinician, phlebotomy at the outpatient clinic or collection site, specimen labeling and transport to the clinical laboratory, accessioning, performance of the immunoassay by a medical laboratory scientist, review of quality controls and result verification by a pathologist or laboratory director, and result reporting to the ordering clinician via the electronic health record or secure messaging. Typical sites of service are outpatient clinics, hospital outpatient departments, urgent care centers, and independent clinical laboratories.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation/oversight portion of a lab test in settings where split billing is allowed. |
| 90 | Reference (outside) laboratory | Use when the specimen is sent to a reference laboratory and the performing lab is different from the billing entity.