Summary & Overview

CPT 86787: Varicella Zoster Antibody Immunoassay

CPT code 86787 represents an immunoassay for antibodies to varicella zoster virus (VZV) performed on serum or cerebrospinal fluid. This laboratory test is clinically important for diagnosing VZV infection, differentiating active versus past exposure, and assessing immunity in patients at risk for complications. Nationally, VZV serology contributes to public health surveillance, preprocedural risk assessment, and management of immunocompromised patients.

Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of clinical context, typical sites of service, common billing modifiers (listed separately), and the role of 86787 in diagnostic workflows. The publication also summarizes benchmarks and reimbursement context where available, highlights relevant coding considerations, and notes when input data were not provided.

This resource is intended for billing managers, laboratory directors, and policy analysts who need a clear reference on clinical purpose, service setting, and payer coverage landscape for CPT code 86787. Data not available in the input are identified explicitly in relevant sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare86787CPTVaricella ZosterImmunoassaySerologyClinical LaboratoryInfectious DiseaseLaboratory Billing

Billing Code Overview

CPT code 86787 describes an immunoassay performed by a laboratory analyst to detect antibodies to varicella zoster virus in a patient’s serum or cerebrospinal fluid. This test evaluates immune response to varicella zoster, the virus that causes chickenpox and shingles, and aids in diagnosis of active or past infection and in assessment of immune status.

Service Type: Laboratory — Infectious Disease Serology / Immunoassay

Typical Site of Service: Clinical laboratory or hospital laboratory; specimens are collected in outpatient clinics, inpatient settings, or other sites where blood or cerebrospinal fluid collection is performed.

Clinical & Coding Specifications

Clinical Context

A 45-year-old outpatient presents to an ambulatory clinic with a painful vesicular rash localized to the right thoracic dermatome and a history of prior varicella infection in childhood. The clinician suspects herpes zoster (shingles) and orders serologic testing to evaluate varicella zoster virus (VZV) antibodies to determine immune status or to support diagnosis when PCR or direct viral testing is unavailable. A phlebotomist collects a serum specimen; the specimen is sent to the clinical laboratory. A medical laboratory scientist performs an immunoassay for VZV IgM and/or IgG on the serum (or cerebrospinal fluid if neurologic complications are suspected). The lab documents results and reports them to the ordering provider. Typical site of service is an outpatient clinic or hospital laboratory; this test may also be performed in an inpatient setting when complications such as encephalitis are evaluated.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician interpretation portion if the lab split billing applies.
`TC`	Technical component	Use when billing only the laboratory technical component (equipment, technician, reagents).
`59`	Distinct procedural service	Use when this immunoassay is a distinct service from other lab tests on the same day.
`91`	Repeat clinical diagnostic laboratory test	Use when repeating the same lab test on the same day for verification.
`90`	Reference laboratory	Use when testing is performed by an outside reference laboratory.
`QW`	CLIA-waived test	Use only if the performed immunoassay is CLIA-waived; rarely applicable for VZV serology in a lab setting.
`52`	Reduced services	Use when the test is partially performed or truncated for clinical reasons.
`53`	Discontinued procedure	Use if specimen collection or testing was started but discontinued.
`76`	Repeat procedure by same provider	Use if the same provider repeats the immunoassay procedure.
`78`	Unplanned return to the operating/procedure room	Not typically used for this lab test; include only if related procedural events require it.
`90`	(duplicate entry avoided)	(See above)

Taxonomy Code	Specialty	Notes
`0000A`	Medical Laboratory Technologist	Performs and validates immunoassays in the clinical lab.
`0000B`	Pathologist	Provides oversight and interpretation when a professional component is billed (`26`).
`0000C`	Infectious Disease Specialist	Orders testing for complex or atypical presentations.
`0000D`	Primary Care Physician	Frequently orders VZV serology for outpatient diagnosis and immunity assessment.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`B02.9`	Zoster without complications	Common indication for VZV antibody testing when shingles is suspected.
`B02.0`	Zoster encephalitis	When neurological complications are suspected, CSF testing for VZV antibodies may be performed.
`B01.9`	Varicella without complications	Serologic testing to confirm prior varicella infection or immunity status.
`B02.2`	Zoster with ocular complications	VZV testing may be used in workup of ocular involvement.
`M79.6`	Pain in limb, unspecified	Symptom code that may accompany shingles presentations prompting VZV testing.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36415`	Collection of venous blood by venipuncture	Specimen collection required before performing the VZV immunoassay.
`88172`	Immunohistochemistry / special stain, interpretation and report	Used in pathology contexts; not routinely paired but may be part of a broader diagnostic workup.
`87496`	Infectious agent antigen detection by immunoassay; varicella zoster virus (VZV)	Alternative or complementary direct antigen testing when available; may be ordered alongside serology.
`89049`	Unlisted microbiology procedure	Used when a specific VZV testing method has no dedicated code; rarely used if assay is atypical.
`86787`	Varicella zoster virus antibody immunoassay	The primary serologic test performed to detect VZV antibodies in serum or CSF.