Summary & Overview
CPT 86765: Rubeola (Measles) Antibody Immunoassay
CPT code 86765 designates a laboratory immunoassay for detection of serum antibodies to rubeola (measles). This test identifies immune response or prior exposure to the rubeola virus and is used in clinical diagnosis, public health investigations, and pre- and post-vaccination assessments. Nationally, antibody testing for vaccine-preventable diseases remains a routine component of laboratory services for infectious disease surveillance and individual patient care.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of coding context for CPT code 86765, including typical sites of service and clinical use. The publication also provides benchmarking and coverage considerations across major payers, notes on billing practices, and clinical context for interpretation of test results. Where available, payer-specific reimbursement patterns and policy updates are summarized to inform laboratory administrators, billing professionals, and clinicians about common coverage scenarios and documentation expectations.
The content is intended as a national reference for billing and clinical stakeholders seeking concise information on CPT code 86765, its clinical role, and where to focus administrative and coding attention when reporting this laboratory immunoassay.
Billing Code Overview
CPT code 86765 describes an immunoassay performed by a laboratory analyst to detect antibodies to rubeola (measles) in a patient's serum. This is a laboratory diagnostic test used to determine prior exposure or immune response to the rubeola virus.
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Service type: Laboratory diagnostic immunoassay
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Typical site of service: Clinical laboratory or hospital laboratory setting
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Clinical & Coding Specifications
Clinical Context
A 28-year-old pregnant woman presents to her obstetrics clinic for routine prenatal screening. She reports no history of confirmed measles (rubeola) or prior vaccination documentation. The clinician orders serologic testing to evaluate immunity to rubeola. A phlebotomy technician collects a serum specimen which is sent to the hospital laboratory. A laboratory technologist performs an immunoassay to detect anti-rubeola IgG and/or IgM antibodies using automated analyzers. Results indicating protective IgG confirm immunity; a negative or equivocal IgG with clinical concern or symptoms may prompt repeat testing, IgM testing, or public health notification. Typical site of service is an outpatient clinic, hospital laboratory, or reference laboratory supporting ambulatory and inpatient services. Specimen handling, chain of custody, and result reporting follow institutional laboratory policies and state public health regulations.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unmodified service | Rarely used; denotes standard service without special reporting when payer-specific modifier not required |
26 | Professional component | When reporting only the professional interpretation portion if the immunoassay requires professional interpretation separate from technical work |
TC | Technical component | When the laboratory reports only the technical component (instrumentation, reagents, and technician time) without professional interpretation |
91 | Repeat clinical diagnostic laboratory test | When the same test is repeated on a separate specimen to confirm unexpected or equivocal results |
90 | Reference laboratory | When the specimen is sent to or performed by an outside/reference laboratory |
59 | Distinct procedural service | If another unrelated service is performed on the same day and needs differentiation from the immunoassay |
52 | Reduced services | When testing is partially performed or limited, e.g., partial panel or insufficient sample leading to limited testing |
53 | Discontinued procedure | If testing was started but discontinued due to specimen issues or patient factors |
QW | CLIA waived test | If the performed immunoassay is CLIA-waived and reported as such by the performing site |
QK | CLIA moderate complexity PPM | When test is performed under a private payor modifier for moderate complexity testing by a qualified laboratory |
QX | Performed by an auxiliary staff under supervision | When a credentialed auxiliary performs the test under appropriate supervision and payer requires identification |
90 | Reference laboratory | When an external lab performs the service and billing needs to reflect reference testing |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207Q00000X | Infectious Disease | Specialists ordering confirmatory testing, consultation for complex cases |
| 207L00000X | Pathology | Pathologists oversee laboratory testing, quality control, and result validation |
| 207K00000X | Obstetrics & Gynecology | Common ordering specialty for prenatal rubeola immunity screening |
| 207L00000X | Clinical Laboratory | Laboratory medicine professionals and clinical chemists performing and supervising immunoassays |
| 207M00000X | Pediatrics | Pediatricians order rubeola serology in children with exposure or unclear vaccination history |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
Z11.3 | Encounter for screening for infections with a predominantly sexual mode of transmission | Used for screening encounters; sometimes applied for immunity screening workflows when a screening visit is documented |
Z28.1 | Immunization not carried out because of contraindication | May be relevant if patient cannot receive MMR vaccination and serology is used to determine immunity |
Z23 | Encounter for immunization | Relevant when serology guides immunization decisions during prenatal or occupational health visits |
O99.5 | Diseases of the nervous system associated with pregnancy, childbirth and the puerperium (placeholder for pregnancy-related infectious disease concerns) | Used when evaluating infections and immunity in pregnant patients (note: clinical specificity must be applied by coder) |
B05.9 | Measles without complication | Relevant when serology is used in suspected or confirmed measles infection evaluation |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
86765 | Rubeola (measles) antibody; immunoassay | Primary code describing the immunoassay performed on serum to detect antibodies to rubeola |
86766 | Rubella antibody; immunoassay | Often ordered alongside rubeola testing to assess immunity to rubella in prenatal screening |
86769 | Mumps antibody; immunoassay | Frequently part of MMR-related serologic panels when assessing viral immunity |
86308 | Antibody; infectious agent, qualitative or semiquantitative, single step method | Alternative generic code for certain qualitative immunoassays when specific organism code not used |
99000 | Handling and/or conveyance of specimen for transfer from physician to laboratory | Administrative/service code sometimes used for specimen handling when applicable |