Summary & Overview
CPT 86784: Trichinella Antibody Immunoassay
CPT code 86784 represents a laboratory immunoassay to detect antibodies to Trichinella, the parasite responsible for trichinosis. As a specialized serologic test, it informs diagnosis in patients with compatible symptoms or exposure history and affects infectious disease workups at the national level. Use of this code matters for laboratory billing, public health surveillance, and accurate capture of parasitic disease testing across care settings.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for when the test is ordered, typical sites of service, and payer relevance. The publication outlines billing benchmarks, common modifiers and administrative considerations, and recent policy updates affecting laboratory test reimbursement. Additionally, it provides guidance on documentation elements and expected clinical indications for ordering the assay.
The material is designed for laboratory administrators, medical coders, billing staff, and clinical leaders seeking a national overview of CPT code 86784, its role in diagnostic workflows, and the administrative context for reimbursement and reporting. Data not available in the input will be noted where relevant.
Billing Code Overview
CPT code 86784 describes an immunoassay performed by a laboratory analyst to detect antibodies to Trichinella, the parasitic agent that causes trichinosis. This test evaluates a patient’s serum for an immune response indicative of current or recent Trichinella infection.
Service Type: Laboratory — Serological Immunoassay
Typical Site of Service: Clinical laboratory or hospital laboratory
Clinical & Coding Specifications
Clinical Context
A patient presents to an outpatient infectious disease clinic or primary care office with acute onset fever, myalgias, periorbital edema, and gastrointestinal symptoms after recent consumption of undercooked pork or wild game. The clinician suspects trichinosis (trichinellosis) based on exposure history and clinical signs. Initial evaluation includes history, physical exam, and routine labs (CBC with eosinophilia, creatine kinase if myositis suspected). A serum specimen is sent to the laboratory for an immunoassay to detect antibodies to Trichinella (test reported under 86784).
The typical workflow: a phlebotomist draws blood in the clinic or hospital outpatient lab; the specimen is labeled and sent to a reference or hospital laboratory. The lab analyst performs the immunoassay, documents results in the laboratory information system, and reports positive, negative, or equivocal antibody findings to the ordering provider. Results are used by the clinician to confirm infection, guide antiparasitic therapy, and determine need for further testing or public health reporting. Typical site of service is outpatient clinic, hospital outpatient laboratory, or reference laboratory; testing may also occur in inpatient settings when clinically warranted.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Primary service | When this laboratory service is the primary service on a claim for that date of service. |