Summary & Overview
CPT 86780: Treponema pallidum Antibody Immunoassay
CPT code 86780 denotes a laboratory immunoassay performed to detect antibodies to Treponema pallidum, the bacterium that causes syphilis. This serologic test is a cornerstone of syphilis diagnosis and surveillance and carries national relevance for public health screening, prenatal care, and sexually transmitted infection management. Testing accuracy and appropriate use influence clinical decision-making, follow-up testing algorithms, and population-level reporting.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical purpose of the test, typical sites where the service is performed, and payer coverage patterns. The publication provides benchmark information on coding and reimbursement, notes on common billing modifiers, and discussion of clinical context such as screening and diagnostic roles of serologic treponemal assays.
The article is organized to deliver practical reference material: a clear description of the code, payer considerations, common coding and billing practices, and clinical implications for use of serologic testing for syphilis. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 86780 describes an immunoassay for antibodies to Treponema pallidum, the spirochete bacterium that causes syphilis. The procedure evaluates a patient’s serum to detect antibodies indicative of current or prior infection.
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Service type: Clinical laboratory test — serologic antibody immunoassay
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Typical site of service: Clinical laboratory, hospital laboratory, outpatient clinic laboratory, or other licensed laboratory testing facility
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Clinical & Coding Specifications
Clinical Context
A 28-year-old sexually active patient presents to an outpatient primary care clinic for routine sexually transmitted infection screening after a new sexual partner. The clinician obtains a blood sample during the visit and orders an immunoassay for treponemal antibodies to evaluate exposure to Treponema pallidum. The blood specimen is sent to the facility laboratory where a medical laboratory scientist or lab analyst performs the immunoassay test, documents results in the electronic health record, and reports reactive results to the ordering provider for confirmatory testing and public health reporting as required. Typical workflow steps include patient history and consent, venipuncture in the clinic or lab draw station, specimen labeling and transport to the lab, performance of the immunoassay, verification by a licensed technologist, result entry, and notification to the ordering provider and patient. Typical sites of service are outpatient clinic laboratories, hospital laboratories, and public health laboratories. Common clinical indications include routine STD screening, symptomatic evaluation for genital ulcers or systemic symptoms, prenatal screening, or partner exposure notification.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting only the professional interpretation component and the laboratory splits technical and professional billing. |