Summary & Overview
CPT 86713: Legionella Antibody Immunoassay, Serum
CPT code 86713 represents a laboratory immunoassay for detecting Legionella antibodies in patient serum. This serologic test aids clinical evaluation for Legionella infection and can support diagnosis when used alongside clinical assessment and other laboratory or microbiologic tests. Nationally, accurate coding and clear clinical indications matter for laboratory reporting, test utilization oversight, and infectious disease surveillance.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for Legionella serology, typical sites of service, and operational considerations for billing and documentation. The publication summarizes common modifiers observed in practice and highlights which elements of policy and reimbursement are relevant to laboratory services.
This report provides benchmarks where available, clarifies coding nomenclature for laboratory services, and outlines areas where policy updates or payer guidance commonly affect claims processing for serologic testing. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 86713 describes an immunoassay performed by a laboratory analyst to detect Legionella antibodies in a patient's serum. This test evaluates serologic evidence of current or past infection with Legionella species and is a laboratory infectious disease serology service.
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Service type: Laboratory immunoassay serology test
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Typical site of service: Clinical laboratory or hospital laboratory setting
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 56-year-old man presents to the emergency department with a 5-day history of high fever, productive cough, shortness of breath, and right-sided pleuritic chest pain. Chest radiograph demonstrates a right lower lobe consolidation. The treating clinician suspects atypical or environmental causes of pneumonia, including Legionella species, based on severe presentation and recent hotel stay with potential exposure to contaminated water sources. A serum specimen is collected and sent to the clinical laboratory for an immunoassay to evaluate for the presence of Legionella antibodies. The laboratory analyst performs 86713 (immunoassay for Legionella antibodies), documents assay method and results in the laboratory information system, and reports a positive IgM and rising IgG titer that supports a presumptive diagnosis of Legionnaires’ disease. This result is used in conjunction with clinical findings, cultures, and urinary antigen testing to guide epidemiologic reporting and therapy adjustments. Typical site of service: hospital laboratory, commercial reference laboratory, or public health/departmental laboratory.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation/consultative portion if the performing lab separates technical and professional components. |