Summary & Overview
CPT 86762: Rubella Antibody Immunoassay, Serum
CPT code 86762 represents a laboratory immunoassay to detect serum antibodies to rubella. This serologic test is clinically important for assessing immunity, guiding prenatal care, and evaluating suspected rubella exposure. Nationally, rubella antibody testing supports public health objectives around congenital rubella prevention and informs individual clinical management.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for rubella serology, common sites where the service is delivered, typical billing considerations, and payor coverage patterns where available. The publication summarizes benchmark payment information, common modifiers used with laboratory services, and coding relationships relevant to laboratory laboratories and clinicians ordering serologic testing.
The piece also outlines operational implications for laboratories and billing teams, such as service-line placement and documentation expectations tied to serology testing. Data not available in the input will be noted where applicable. This national summary aims to clarify what CPT code 86762 covers and what stakeholders should expect when encountering this code in claims and clinical workflows.
Billing Code Overview
CPT code 86762 describes an immunoassay performed by a laboratory analyst to evaluate a patient’s serum for antibodies to rubella. This test detects immune response to rubella virus and is used in clinical assessment of past infection or immunity, including prenatal screening and post-exposure evaluation.
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Service type: Laboratory diagnostic serology
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Typical site of service: Clinical laboratory or hospital laboratory
Clinical & Coding Specifications
Clinical Context
A typical patient is a pregnant woman in prenatal care or an adult with possible exposure to rubella who requires serologic assessment of immunity. The clinician orders an immunoassay for rubella IgG and/or IgM when determining immunity status before or during pregnancy, evaluating a febrile rash illness, or screening healthcare workers and students. The workflow: a phlebotomist draws a serum specimen, labels and sends it to the clinical laboratory; a laboratory technologist performs the immunoassay (86762) using automated serology platforms; results (IgG positive indicating immunity, IgM positive suggesting recent infection) are reported to the ordering provider. Documentation includes the reason for testing (e.g., prenatal screen, rash evaluation, exposure), specimen date/time, assay method, and result interpretation in the medical record. Results inform counseling, infection control actions, and public health reporting when acute rubella is suspected.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the interpretation/reading by a physician of the lab result separate from the technical test. |
TC |