Summary & Overview
CPT 86804: Confirmatory Hepatitis C (HCV) Antibody Assay
CPT code 86804 represents a laboratory confirmatory assay for hepatitis C virus (HCV) antibodies, typically performed after an initial reactive screening test to establish serologic evidence of HCV exposure. This confirmatory testing plays a key role in diagnosing past or present infection and guiding further clinical evaluation, including RNA testing and linkage to care. Nationally, standardized reporting and coding for confirmatory HCV antibody assays affect surveillance, care pathways, and laboratory billing practices.
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 context for confirmatory HCV antibody testing, expected sites of service, and the typical laboratory workflow associated with this procedure. The publication also outlines common billing considerations, frequently used modifiers (provided in the input), and where CPT code 86804 fits within laboratory service lines.
This summary provides a practical reference for billing and coding staff, laboratory managers, and policy analysts interested in how confirmatory serologic assays for HCV are captured in claims and the implications for clinical follow-up and public health reporting. Data not available in the input is noted where relevant.
Billing Code Overview
CPT code 86804 describes a laboratory assay performed by a lab analyst to confirm the presence of antibodies to hepatitis C virus (HCV) in a patient’s blood. The procedure typically uses a confirmatory method such as immunoblot (Western blot) to verify reactive screening results and establish serologic evidence of HCV exposure.
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Service type: Confirmatory serologic antibody assay for hepatitis C (HCV)
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Typical site of service: Clinical laboratory or hospital laboratory setting
Clinical & Coding Specifications
Clinical Context
A 38-year-old patient presents to an outpatient phlebotomy clinic after a primary care visit that reported a positive screening hepatitis C antibody test. The clinician orders a definitive confirmatory antibody assay to distinguish true seropositivity from a false-positive screening result. The patient is registered, blood is collected by a phlebotomist and sent to the clinical laboratory. A laboratory technologist or medical technologist performs the confirmatory immunoblot (Western blot) or other FDA-cleared supplemental antibody assay, documents results in the laboratory information system, and reports positive, negative, or indeterminate findings to the ordering provider. Typical workflow elements include specimen accessioning, performance of the confirmatory serologic assay, quality controls, interpretation by the lab analyst, and transmission of results to the ordering clinician. Typical site of service is an outpatient clinical laboratory, hospital laboratory, or reference lab; sample collection often occurs in an ambulatory clinic or phlebotomy center.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/No modifier | Used when no other modifier is applicable and full global service is reported |
11 |