Summary & Overview
CPT 86735: Mumps Virus Antibody Immunoassay
CPT code 86735 represents a laboratory immunoassay to detect serum antibodies to the mumps virus. This serologic test is clinically important for diagnosing recent or prior mumps infection and for assessing immune status, with implications for public health surveillance and clinical management. As a commonly ordered infectious disease serology, it intersects with laboratory policy, payer coverage rules, and public health reporting.
Key payers covered in this review include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national overview of clinical context and typical sites of service for CPT code 86735, plus summaries of payer coverage considerations and common modifier usage. The publication outlines standard benchmarks for processing and reporting times, typical laboratory service lines, and areas where policy updates or coding guidance are most likely to affect billing and claims adjudication.
This summary aims to inform clinical laboratories, billing teams, and policy analysts about the role of CPT code 86735 in routine and outbreak-related testing, highlight practical coding and billing considerations, and point to where payers commonly focus prior authorization, medical necessity, and documentation review. Data not available in the input are indicated where applicable.
Billing Code Overview
CPT code 86735 describes an immunoassay performed by a laboratory analyst to detect serum antibodies to the mumps virus. The service is a serologic antibody test used to evaluate immune response or possible recent infection with mumps.
Service type: Laboratory serology / immunoassay
Typical site of service: Clinical laboratory or hospital laboratory (outpatient or inpatient specimen processing)
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A pediatric or adult patient presents with parotitis, fever, orchitis, or exposure to a confirmed mumps case in a primary care clinic, urgent care, emergency department, or public health clinic. The clinician orders serologic testing to assess for acute or past infection. A blood specimen is collected; the laboratory performs an immunoassay for mumps-specific IgM and/or IgG antibodies (CPT 86735 covers the immunoassay for mumps antibodies). Typical workflow: patient encounter and history/exam → phlebotomy (blood draw) → specimen labeling and transport to the clinical laboratory → laboratory accessioning → immunoassay testing (enzyme immunoassay/chemiluminescent assay) → result interpretation by the lab analyst and reporting to the ordering clinician. Results support diagnosis, public health reporting, or assessment of immunity status. Typical sites of service include outpatient clinics, urgent care centers, hospital outpatient laboratories, and public health laboratories.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation component of the test if separated from the technical component. |
TC |