Summary & Overview
CPT 86738: Mycoplasma Antibody Immunoassay, Serum
CPT code 86738 denotes a laboratory immunoassay to detect antibodies to Mycoplasma in patient serum. As a widely used serologic test, it informs diagnosis of Mycoplasma infections and can guide clinical management, infection control decisions, and epidemiologic surveillance. Nationally, laboratory test coding like CPT 86738 matters for claims processing, coverage determinations, and standardization of diagnostic reporting across providers and payers.
Key payers in scope include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will gain an understanding of what CPT code 86738 represents clinically and operationally, typical sites where the service is delivered, and which major payers commonly adjudicate claims for this laboratory service.
The publication provides benchmarks and coding context for CPT code 86738, outlines clinical context for Mycoplasma antibody testing, and summarizes any relevant policy or coverage considerations when available. Data not available in the input will be noted as such in detailed sections.
Billing Code Overview
CPT code 86738 describes an immunoassay performed by a laboratory analyst to evaluate a patient’s serum for antibodies to Mycoplasma. This is a clinical laboratory diagnostic test that detects host antibodies indicating current or prior Mycoplasma infection.
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Service type: Clinical laboratory immunoassay
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Typical site of service: Hospital laboratory, independent clinical laboratory, or outpatient laboratory collection site
Clinical & Coding Specifications
Clinical Context
A typical patient is an adolescent or adult presenting with acute respiratory symptoms such as persistent cough, fever, sore throat, or atypical pneumonia signs following a community or household exposure. A primary care physician, urgent care clinician, or emergency department provider orders serologic testing for Mycoplasma pneumoniae when clinical suspicion for atypical bacterial respiratory infection remains after initial evaluation or when molecular testing is unavailable or negative. The sample is a serum specimen collected via routine venipuncture and sent to the clinical laboratory. The laboratory analyst performs an immunoassay (86738) to detect specific IgM and/or IgG antibodies to Mycoplasma. Results are reported to the ordering provider and incorporated into the clinical record to guide antimicrobial decisions, public health reporting, or follow-up testing (e.g., convalescent titers). Typical site of service is an outpatient clinic, urgent care center, hospital outpatient laboratory, or independent clinical laboratory. The service type is diagnostic serology (immunoassay) performed by the clinical laboratory; the typical patient scenario includes suspected atypical pneumonia, persistent cough after usual viral course, or investigation of a community outbreak.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when the physician performs the professional interpretation or result validation separate from the technical lab processing. |