Summary & Overview

CPT 86709: Hepatitis A IgM Antibody Immunoassay

CPT code 86709 designates a laboratory immunoassay that detects hepatitis A virus-specific immunoglobulin M (IgM) in patient serum, indicating recent or acute infection. This test is a key diagnostic tool in identifying active hepatitis A cases, guiding public health response and clinical management. Nationally, accurate billing and classification of this assay affect laboratory reporting, surveillance workflows, and payer coverage determinations.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for acute hepatitis A testing, typical sites of service for the assay, and the common billing considerations tied to laboratory immunoassays. The publication also summarizes benchmarks and coverage patterns where available, highlights relevant policy and coding clarifications, and outlines areas where clinical documentation supports appropriate use of the test.

This summary is intended for laboratory managers, billing professionals, and policy analysts seeking a national-level briefing on CPT code 86709 — what the code represents, why it matters for clinical diagnosis and public health, and the common payer landscape affecting reimbursement and utilization.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 86709hepatitis AIgM antibodyserologylaboratory testimmunoassayinfectious diseaseclinical laboratorydiagnostic testing

Billing Code Overview

CPT code 86709 describes an immunoassay for detection of hepatitis A virus IgM antibodies in a patient’s serum. The procedure is a laboratory serology test used to determine recent or acute infection with hepatitis A by identifying immunoglobulin M (IgM) specific to the virus.

Service type: Laboratory — serologic immunoassay

Typical site of service: Clinical laboratory or hospital laboratory; specimen collection may occur in outpatient clinics or ambulatory settings

Clinical & Coding Specifications

Clinical Context

A 28-year-old adult presents to an outpatient clinic with acute onset jaundice, malaise, abdominal pain, and low-grade fever after recent travel and possible exposure to contaminated food. The clinician orders serologic testing to evaluate for acute hepatitis A infection. A venous blood sample is collected and sent to the clinical laboratory. The laboratory analyst performs an immunoassay to detect hepatitis A virus-specific immunoglobulin M, reported under CPT 86709. Results indicating detectable IgM anti-HAV support a diagnosis of acute hepatitis A; nondetectable IgM with positive IgG may indicate past infection or immunity. Typical workflow steps: provider order entry and indication (suspected acute viral hepatitis), phlebotomy and specimen labeling, transport to the clinical laboratory, performance of the immunoassay by a medical laboratory scientist, verification of results by a supervising pathologist or lab director if required, and result reporting in the electronic health record to guide clinical management.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the professional interpretation or oversight of the laboratory testing when separately reportable by the provider.
`TC`	Technical component	Use when billing only the technical component (lab supplies, instrument, technician) of the test.
`90`	Reference laboratory	Use when the test is sent to a outside reference laboratory and a reporting or ordering provider bills.
`91`	Repeat clinical diagnostic lab test	Use when the same test is repeated on the same day for valid clinical reasons and repeat testing is allowed.
`59`	Distinct procedural service	Use to indicate a distinct test or service that is separate from other services on the same day when necessary to show distinctness.
`90`	(duplicate entry avoided)	Data de-duplication: only one `90` entry is applicable.
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	Rarely applicable; use when lab results are provided during a synchronous telemedicine visit where modifier reporting policies require it.
`91`	(duplicate entry avoided)	As above, only one `91` entry is applicable.

Taxonomy Code	Specialty	Notes
207Q00000X	Infectious Disease	Specialists who interpret serologic testing for hepatitis and manage patients with viral hepatitis.
208000000X	Pathology	Pathologists provide laboratory oversight, interpretation, and result validation.
164W00000X	Laboratory Director	Medical laboratory directors or clinical pathologists responsible for lab quality and reporting.
261QM0800X	Family Medicine	Primary care physicians who order initial hepatitis serologies in outpatient settings.
207L00000X	Gastroenterology	Gastroenterologists involved in evaluation of suspected viral hepatitis and liver disease.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`B15.9`	Acute hepatitis A without hepatic coma	Primary diagnosis indicating acute HAV infection; positive `86709` (IgM anti-HAV) supports this code.
`R17`	Unspecified jaundice	Symptom-driven code that may prompt ordering of `86709` during evaluation of new-onset jaundice.
`R50.9`	Fever, unspecified	Fever in the setting of suspected infection may lead to ordering hepatitis serologies including `86709`.
`K76.9`	Liver disease, unspecified	Used when liver dysfunction is identified and hepatitis serology (`86709`) is part of the diagnostic workup.
`Z20.2`	Contact with and (suspected) exposure to infections with a predominantly fecal-oral transmission route	Use when exposure history to hepatitis A warrants testing with `86709`.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36415`	Collection of venous blood by venipuncture	Performed prior to `86709` to obtain the serum specimen for the hepatitis A IgM immunoassay.
`80061`	Liver function tests; includes AST and ALT (part of hepatic panel)	Often ordered alongside `86709` to assess hepatic injury and correlate serologic results with transaminase elevations.
`86683`	Antibody; hepatitis B core, IgM	Commonly ordered in parallel to evaluate for other acute viral hepatitis causes when assessing acute hepatitis presentation.
`86706`	Antibody; hepatitis A, total (IgG and IgM)	May be ordered with or instead of `86709` when assessing immunity versus acute infection; provides total antibody status.
`87804`	Hepatitis A antigen detection by immunoassay (if available)	Alternative or complementary infectious disease testing in some workflows for acute HAV detection.