Summary & Overview
CPT 86759: Rotavirus Antibody Immunoassay, Serum
CPT code 86759 identifies a laboratory immunoassay that assesses serum for antibodies to rotavirus. This serologic test is used to detect prior exposure or immune response to rotavirus and can inform clinical diagnosis, public health surveillance, and epidemiologic studies. As a specific laboratory CPT code, 86759 is relevant to clinical laboratories, hospital laboratories, and clinicians ordering infectious disease serologies.
Key national payers considered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis addresses coverage and billing patterns across major commercial insurers and the Medicare program to inform billing compliance and administrative workflows.
Readers will find a concise overview of the code’s clinical context, typical sites of service, and the role of the test in patient evaluation. The publication also summarizes common modifiers and payment considerations when available, highlights policy updates affecting laboratory CPT billing, and provides benchmarking information for coding and reimbursement practice. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 86759 describes an immunoassay performed by a laboratory analyst to detect antibodies to rotavirus in patient serum. This is a laboratory diagnostic test used to evaluate serologic evidence of rotavirus infection or immune response.
Service type: Laboratory / Serologic Testing
Typical site of service: Clinical laboratory or hospital laboratory setting
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A pediatric patient aged 6 months presents to an outpatient pediatric clinic with acute onset of watery diarrhea, vomiting, low-grade fever, and signs of mild dehydration after a daycare exposure. The clinician documents concern for viral gastroenteritis, specifically rotavirus infection, and orders laboratory testing to support diagnosis and guide infection control measures. A blood sample is sent to the clinical laboratory where a medical technologist or lab analyst performs an immunoassay to detect serum antibodies to rotavirus, billed as 86759. The typical workflow includes specimen collection at the clinic or hospital phlebotomy station, specimen transport to the microbiology/serology laboratory, performance of the immunoassay (manual or automated enzyme immunoassay/ELISA), result validation by a qualified laboratory director or designee, and communication of results to the ordering provider for clinical correlation and reporting to public health if indicated. Typical site of service is hospital outpatient laboratory, independent diagnostic testing facility (IDTF), or hospital inpatient laboratory when ordered during admission. This test is commonly used when stool testing is unavailable, when serologic confirmation is sought for epidemiology or retrospective diagnosis, or when patients present after the acute stool-shedding period.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician or laboratory professional interpretation/documentation portion separate from technical component. |
TC | Technical component | Use when billing only the technical component (laboratory work, supplies, and equipment) without professional interpretation. |
90 | Reference (outside) laboratory | Use when the performing lab is an outside reference laboratory and the service is being billed by a different entity requiring 90. |
90 (alternate common use) | Unusual to duplicate; included above | - |
52 | Reduced services | Use when the test is partially performed or limited in scope compared with full procedure. |
53 | Discontinued procedure | Use when specimen collection or testing was started but discontinued for clinical reasons before completion. |
59 is not in the provided list and is omitted per input restrictions. | ||
90 duplication note | ||
76 is not in provided list and omitted. | ||
91 is not in provided list and omitted. | ||
22 | Increased procedural services | Use when work required is substantially greater than typically required for the test (documentation required). |
52 | Reduced services | See above; included as relevant to partial testing. |
90 | See above | See above |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 390200000X | Pathology & Laboratory Medicine | Medical pathologists oversee immunoassay validation and result interpretation. |
| 207Q00000X | Pediatric Medicine | Pediatricians commonly order rotavirus testing in infants and young children. |
| 208000000X | Family Medicine | Family physicians order testing for community-managed gastroenteritis. |
| 364S00000X | Clinical Laboratory Science/Medical Technology | Medical laboratory scientists/technologists perform the immunoassay testing. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
A08.0 | Rotaviral enteritis | Primary diagnosis for confirmed or suspected rotavirus infection; directly related to ordering rotavirus antibody testing. |
A09 | Infectious gastroenteritis and colitis, unspecified | Symptomatic presentation where rotavirus is in the differential and serology may assist diagnosis. |
R11.2 | Nausea with vomiting, unspecified | Symptom prompting evaluation for viral gastroenteritis including rotavirus. |
R19.7 | Diarrhea, unspecified | Common presenting symptom leading to stool or serologic testing for rotavirus. |
E86.0 | Dehydration | Complication of rotavirus gastroenteritis; testing supports etiologic diagnosis when dehydration is present. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
87045 | Culture, stool, bacterial, routine and presumptive identification | Stool culture may be ordered to evaluate for bacterial causes of diarrhea when rotavirus is a consideration. |
87086 | Culture, stool, pathogenic organisms; immunoassay for bacterial antigen(s) | Alternative stool antigen testing that may be run alongside viral studies. |
87449 | Infectious agent antigen detection by immunoassay, multiple organisms (e.g., multiplex panels) | Multiplex stool panels that include viral antigen testing can be ordered instead of or in addition to serology. |
87804 | Infectious agent antigen detection by immunoassay, rotavirus | Direct stool antigen immunoassay for rotavirus; commonly performed for acute diagnosis and may be preferred to serum antibody testing. |
36415 | Collection of venous blood by venipuncture | Venipuncture is typically performed to obtain the serum specimen used for 86759. |