Summary & Overview
CPT 86757: Rickettsia Antibody Immunoassay
CPT code 86757 identifies a laboratory immunoassay used to detect antibodies to Rickettsia in a patient’s serum. This serologic test supports clinical evaluation of suspected rickettsial infections and can influence diagnostic and treatment decisions. Nationally, accurate laboratory identification of Rickettsia antibodies is important for infectious disease surveillance and appropriate clinical management.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for CPT code 86757, how the test is typically delivered (clinical or hospital laboratory), and the common settings where the service occurs.
The publication provides benchmarks and operational context relevant to billing and coding for this laboratory service, summarizes payer coverage patterns where available, and outlines clinical considerations tied to test use. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 86757 describes an immunoassay performed by a laboratory analyst to detect antibodies to Rickettsia in the patient’s serum. This test is a serologic assay used to evaluate immune response to Rickettsia species, which can assist in diagnosing rickettsial infections.
Service Type: Laboratory serologic testing (immunoassay)
Typical Site of Service: Clinical laboratory or hospital laboratory (inpatient or outpatient specimen processing and analysis)
Clinical & Coding Specifications
Clinical Context
A 34-year-old patient presents to an outpatient infectious disease clinic with 7 days of fever, headache, myalgias, and a recent history of tick exposure while hiking. The clinician obtains a serum sample to evaluate for rickettsial infection. The sample is sent to the clinical laboratory where a lab analyst performs an immunoassay to detect antibodies to Rickettsia species (86757). Results are used by the ordering clinician to support or exclude a diagnosis of a rickettsial illness (for example, Rocky Mountain spotted fever or other spotted fever group rickettsioses) and to guide further management and reporting to public health if indicated. Typical workflow steps: order placed by clinician, phlebotomy and specimen labeling, specimen receipt and accessioning in the lab, performance of the immunoassay by qualified laboratory personnel, result validation and reporting to the clinician, and documentation in the patient’s medical record. Typical site of service is an outpatient clinic or hospital laboratory performing diagnostic serology; specimen collection occurs in an ambulatory clinic, emergency department, or inpatient unit as clinically indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician or pathologist interpretation portion, separate from the technical lab component. |