Summary & Overview
CPT 86774: Tetanus Antibody Immunoassay, Serum
CPT code 86774 represents a laboratory immunoassay for detection of tetanus antibodies in patient serum, a test used to assess immunity and guide clinical management after potential exposure or to evaluate vaccine response. Nationally, serologic testing for tetanus antibodies is an important public health and clinical tool for confirming immunity status in uncertain histories and for epidemiologic surveillance.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how CPT code 86774 is positioned clinically, the typical settings where the service is performed, and the payer landscape relevant to this laboratory procedure. The publication outlines common billing considerations and provides benchmarks where available, as well as notes on coding context and service-line placement.
The report is intended to inform laboratory managers, billing professionals, and policy analysts about the role of CPT code 86774 in routine and exposure-related testing protocols. It highlights clinical context, payer coverage considerations, and operational settings for the test. Data not available in the input are explicitly noted where applicable.
Billing Code Overview
CPT code 86774 describes an immunoassay performed by a laboratory analyst to detect antibodies to tetanus in a patient's serum. This test evaluates immune response to tetanus toxin and is used in clinical assessment of immunity or suspected tetanus exposure.
Service Type: Laboratory — immunoassay serology
Typical Site of Service: Clinical laboratory, hospital laboratory, or reference laboratory
Data not available in the input for payers, associated taxonomies, ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A 34-year-old adult presents to an urgent care clinic after sustaining a puncture wound from a rusty nail. The treating clinician documents an unclear or incomplete tetanus immunization history and orders a tetanus antibody level to assess immune status prior to deciding on tetanus immune globulin or booster vaccination. A phlebotomist collects a serum specimen and the specimen is sent to the outpatient clinical laboratory. The laboratory analyst performs an immunoassay to detect and quantify antibodies to tetanus toxoid (CPT 86774). Results are reported to the ordering clinician; if antibody levels are protective, the clinician may defer passive immunization or booster administration, whereas nonprotective titers prompt administration of tetanus vaccine or immunoglobulin according to clinical protocols. Typical sites of service include outpatient laboratory, hospital outpatient laboratory, urgent care clinic with laboratory services, and reference diagnostic laboratories. The clinical workflow includes order entry, specimen collection and labeling, transport to the lab, accessioning, assay performance, result verification by a qualified laboratory professional, and result reporting into the electronic health record.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When only the professional interpretation or reporting component of the laboratory test is billed separately by a physician or qualified practitioner |
TC | Technical component | When only the technical component (laboratory performance, equipment, and supplies) is billed by the facility performing the assay |
90 | Reference laboratory | When the test is performed by an independent or outside reference laboratory and the performing lab is different from the billing entity |
59 | Distinct procedural service | When this laboratory test is distinct and separate from other services on the same day and needs to be identified as separate (use with caution) |
52 | Reduced services | When the assay is partially performed or a reduced service is provided compared with the full procedure |
53 | Discontinued procedure | When specimen collection or testing was started but discontinued for documented clinical reasons prior to completion |
90 | Reference laboratory | When the specimen is sent to a non-billing external laboratory for testing (note: 90 already listed — include once in claims) |
90 | Reference laboratory | When the specimen is sent to a non-billing external laboratory for testing (duplicate entries are not necessary) |
90 | Reference laboratory | Data not duplicated; see above |
90 | Reference laboratory | Data not duplicated; see above |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207Q00000X | Clinical Laboratory | Laboratory directors, clinical pathologists, and clinical laboratory scientists oversee testing operations |
| 207RG0100X | Clinical Pathology | Physicians specializing in clinical pathology interpret and validate immunoassay results |
| 207L00000X | Medical Laboratory Technologist/Technician | Personnel who perform the assay and instrument operation |
| 208D00000X | Infectious Disease | Infectious disease specialists order and interpret serologic immunity testing in complex cases |
| 261QM0800X | Emergency Medicine | Emergency and urgent care clinicians frequently order tetanus antibody testing in wound management |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
Z23 | Encounter for immunization | Used when assessing immunity status and planning tetanus vaccination based on antibody results |
T79.A11A | Traumatic amputation involving other multiple fingers, initial encounter | Example traumatic wound scenario where tetanus immunity assessment may be indicated |
S81.811A | Laceration without foreign body of right lower leg, initial encounter | Common wound presentation prompting tetanus antibody testing to assess need for prophylaxis |
W25.XXXA | Contact with powered lawn mower, initial encounter | Mechanism of injury that increases tetanus risk and may prompt antibody testing |
Z71.1 | Person with feared health complaint in whom no diagnosis is made | Situations where immune status evaluation is part of counseling and evaluation |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
36415 | Collection of venous blood by venipuncture | Specimen collection prior to sending serum for tetanus antibody immunoassay |
80061 | Lipid panel (example of common additional chemistry testing) | Often ordered during comprehensive lab workups though not specific to tetanus testing; included as an example of concurrent outpatient lab testing |
86880 | Antibody identification, non-specified (immunoassay) | Other immunoassays for antibody detection; may be performed in the same lab workflow when multiple serologies are required |
G0008 | Administration of tetanus toxoid-containing vaccine (Medicare - influenza/pneumococcal context) | Administrative codes for vaccine administration are used when a tetanus booster is given after antibody results indicate nonprotective levels |
96372 | Therapeutic, prophylactic, or diagnostic injection (e.g., tetanus immune globulin) | Used for administration of tetanus immune globulin or other injections that may follow nonprotective antibody results |