Summary & Overview
CPT 86800: Thyroglobulin Antibody Immunoassay, Serum
CPT code 86800 denotes a laboratory immunoassay performed on patient serum to detect antibodies to thyroglobulin. This test is clinically relevant for identifying autoimmune thyroid disorders and for monitoring patients with thyroid disease. As a widely used serologic assay, it features in national laboratory testing portfolios and interacts with major payers for coverage and reimbursement across outpatient and inpatient laboratory settings.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical purpose of the test, typical sites of service, common modifiers in billing practice, and which payers are commonly involved in coverage decisions. The publication summarizes benchmark pricing and reimbursement patterns where available, highlights relevant policy updates affecting laboratory immunoassays, and provides clinical context for interpretation of test use.
This summary equips billing managers, laboratory directors, and policy analysts with a clear understanding of what CPT code 86800 represents, why it matters in national laboratory practice, and where to look for payer-specific guidance and performance benchmarks.
Billing Code Overview
CPT code 86800 describes an immunoassay performed on serum to detect antibodies to thyroglobulin, a protein produced by the thyroid gland that plays a role in synthesis, storage, and release of thyroid hormones. The procedure involves laboratory analysis of a patient’s serum to evaluate the presence and level of anti-thyroglobulin antibodies, which can aid in assessment of autoimmune thyroid disease and monitoring of certain thyroid conditions.
Service Type: Laboratory immunoassay (serologic antibody testing)
Typical Site of Service: Clinical laboratory or hospital laboratory
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 45-year-old female with a history of autoimmune thyroid disease presents for laboratory monitoring of thyroid autoantibodies. Her endocrinologist orders an immunoassay to detect and quantify antibodies to thyroglobulin to evaluate autoimmune thyroiditis activity and to assist in differential diagnosis of hypothyroidism. The clinical workflow: the outpatient clinic obtains a venous serum sample, labels and sends it to the hospital clinical laboratory or an independent reference laboratory. A medical laboratory scientist or lab analyst performs the immunoassay using validated platforms (e.g., chemiluminescent or ELISA) and reports qualitative or quantitative anti-thyroglobulin results to the ordering provider. Results are reviewed by the endocrinologist, documented in the electronic medical record, and used to guide management such as monitoring disease progression, interpreting thyroid function tests, or assessing risk of autoimmune thyroid disease in context of other clinical findings.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional (interpretive) portion performed by a pathologist or laboratory physician. |
TC | Technical component | Use when billing only the technical component (laboratory processing, reagents, instrumentation). |
90 | Reference (outside) laboratory | Use when the test is sent to an outside reference lab and only reporting is billed by the ordering facility. |
91 | Repeat clinical diagnostic laboratory test | Use when the same test is repeated on the same day to confirm results. |
59 | Distinct procedural service | Use when this assay is billed with another separately identifiable service that is not typically bundled. |
52 | Reduced services | Use when the laboratory performs a partial or limited version of the assay. |
53 | Discontinued procedure | Use when specimen processing was started but discontinued due to an approved reason. |
76 | Repeat procedure by same provider (not in list but commonly used) | Data not available in the input. |
90 | Duplicate entry prevented; retained above | Use as described above. |
QW | CLIA waived test | Use when the assay is a waived test performed under CLIA waiver (rare for immunoassays like anti-thyroglobulin). |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RH0000X | Endocrinology, Adult | Endocrinologists frequently order and interpret thyroglobulin antibody testing. |
| 207K00000X | Obstetrics & Gynecology | OB/GYN clinicians may order thyroid antibody testing in pregnancy evaluation. |
| 207L00000X | Hematology & Oncology | Oncologists/endocrine surgeons may use thyroglobulin antibodies when monitoring differentiated thyroid cancer. |
| 207R00000X | Internal Medicine | General internists order and manage thyroid autoimmune evaluations. |
| 363L00000X | Clinical Laboratory | Laboratory medicine specialists perform and supervise the assay. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
E06.3 | Autoimmune thyroiditis | Anti-thyroglobulin antibodies are commonly positive in autoimmune (Hashimoto) thyroiditis and used for diagnosis and monitoring. |
E03.9 | Hypothyroidism, unspecified | Antibody testing helps determine autoimmune etiology in patients with hypothyroidism. |
E05.90 | Thyrotoxicosis, unspecified without thyrotoxic crisis | Thyroid antibody panels can aid in distinguishing autoimmune hyperthyroidism (e.g., Graves') from other causes. |
C73 | Malignant neoplasm of thyroid gland | Anti-thyroglobulin antibodies and thyroglobulin testing are used in surveillance of differentiated thyroid cancer. |
Z86.39 | Personal history of other endocrine, nutritional and metabolic disease | Past thyroid disease surveillance may include periodic antibody measurement. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
80048 | Thyroid profile, total or free (T3, free T4, TSH) | Often ordered alongside thyroglobulin antibody testing to assess thyroid function status. |
84436 | Thyroid stimulating hormone (TSH) | Common reflex or concurrent test to correlate antibody status with thyroid function. |
84443 | Thyroxine; free (FT4) | Used with antibody testing to evaluate thyroid hormone levels and diagnose hypothyroidism or hyperthyroidism. |
84439 | Thyroxine; total (T4) | Alternative or complementary hormone measurement performed in the same diagnostic evaluation. |
84480 | Thyroglobulin | Measurement of thyroglobulin protein often ordered with anti-thyroglobulin antibodies in thyroid cancer surveillance. |