Summary & Overview
CPT 86750: Plasmodium Antibody Immunoassay
CPT code 86750 designates a laboratory immunoassay for detection of antibodies to Plasmodium, the parasite that causes malaria. This serologic assay supports clinical diagnosis when parasitemia is low, for epidemiologic investigations, or when supplemental testing for malaria exposure is needed. Nationally, standardized reporting and appropriate laboratory coding for infectious disease serology are important for surveillance, billing consistency, and public health tracking.
Key payers in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of what CPT code 86750 represents, the clinical context for ordering the test, expected sites of service, and typical considerations for laboratory-based infectious disease testing. The publication summarizes benchmarking concepts, common reimbursement considerations, and relevant policy or coding updates where available.
This summary provides a national perspective useful to laboratory managers, billing professionals, and clinicians seeking clarity on the clinical role and billing identity of CPT code 86750. Data not available in the input is noted where applicable in detailed sections.
Billing Code Overview
CPT code 86750 describes a laboratory immunoassay procedure performed by a lab analyst to evaluate a patient’s serum for antibodies to Plasmodium (the malaria parasite). This test is a serologic antibody assay used to detect immune response to Plasmodium species.
Service Type: Laboratory — Infectious Disease Serology
Typical Site of Service: Clinical laboratory or hospital laboratory
Clinical & Coding Specifications
Clinical Context
A 32-year-old traveler presents to an outpatient infectious disease clinic 10 days after returning from sub-Saharan Africa with fever, sweats, myalgias and intermittent chills. The clinician obtains a serum sample and orders an immunoassay for antibodies to Plasmodium species to support evaluation for malaria after initial rapid diagnostic testing and microscopy. The laboratory receives the serum specimen, logs it, and the lab analyst performs an immunoassay (enzyme-linked immunoassay or rapid immunochromatographic assay) to detect IgM/IgG antibodies to Plasmodium. Results are reviewed by the clinical laboratory scientist, verified, and reported to the ordering provider. Typical site of service is a hospital outpatient laboratory, reference laboratory, or an ambulatory clinic with on-site lab services. Common clinical workflow steps include specimen collection, accessioning, performance of the immunoassay, quality controls, interpretation, and electronic reporting to the clinician.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no specific modifier applies to the claim |
11 | Office or other outpatient visit, or general modifier denoting primary service | Use to indicate the primary procedure when required by payer systems |
26 | Professional component | Use when billing only the professional interpretation or oversight portion of the test |
TC | Technical component | Use when billing only the technical component (laboratory processing and equipment) |
90 | Reference (outside) laboratory | Use when the service was performed by an outside/reference laboratory |
52 | Reduced services | Use when the immunoassay was partially performed or abbreviated per medical necessity |
53 | Discontinued procedure | Use when testing was started but discontinued due to specimen issues or instrument failure |
78 | Return to the operating/procedure room | Rare for lab testing; use if procedure-related return occurred (not typically used) |
80 | Assistant surgeon | Not applicable to lab testing; included only if required by payer (rare) |
90 | Reference (duplicate entry) | See above; appears in input list and is used for outside lab billing |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 367500000X | Pathology & Laboratory | Clinical laboratory directors and pathologists supervising serologic testing |
| 207L00000X | Infectious Disease | Infectious disease specialists ordering and interpreting malaria serology |
| 207Q00000X | Emergency Medicine | Emergency physicians ordering initial diagnostic testing in returned travelers |
| 363LP0800X | Clinical Laboratory Technologist | Laboratory technologists and analysts performing the immunoassay |
| 208000000X | Internal Medicine | Hospitalists or internists managing febrile patients and ordering testing |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
B50.9 | Plasmodium falciparum malaria, unspecified | Common malaria species; serology may support diagnosis in conjunction with microscopy or antigen testing |
B51.9 | Plasmodium vivax malaria, unspecified | Another common species; antibody testing can aid in retrospective or supportive diagnosis |
R50.9 | Fever, unspecified | Frequent presenting symptom prompting malaria serologic testing in returned travelers |
A06.9 | Amoebiasis, unspecified | Enteric infections considered in differential for travel-related febrile illness; serology sometimes performed |
A04.7 | Enterocolitis due to Clostridium difficile | Part of broader infectious workup when gastrointestinal symptoms accompany fever |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
87070 | Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates | May be ordered concurrently if bacterial infection is in the differential diagnosis of febrile traveler |
87077 | Culture, pathogenic organism, not elsewhere specified; aerobic, with isolation and presumptive identification | Alternative microbiology services performed when bacterial sepsis is considered |
87086 | Culture, fungal; any source except blood, with isolation and presumptive identification | Ordered when fungal infections are considered in the differential for prolonged fevers |
86580 | Skin test, tuberculosis (tine test) | TB testing may be part of infectious workup in returning travelers depending on exposure history |
87804 | Infectious agent antigen detection by immunoassay technique, multiple types | Other immunoassays (antigen detection) that may be used alongside antibody testing for infectious agents |