Summary & Overview
CPT 86805: Donor Lymphocyte–Recipient Serum Crossmatch Test
CPT code 86805 represents a donor lymphocyte–recipient serum crossmatch assay used to detect antibody‑mediated incompatibility prior to organ or tissue transplant. This laboratory procedure is clinically important because it helps identify immunologic risk that can affect transplant selection, perioperative planning, and post‑transplant immunosuppression strategies. Nationally, compatibility testing is a routine step in transplantation workflows and has implications for laboratory capacity, coding accuracy, and payer coverage.
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 and service settings for 86805, plus national benchmarking considerations for billing and reimbursement, common modifiers encountered in claims processing, and the clinical context in which the test is ordered. The publication also outlines typical sites of service and operational implications for hospital and reference laboratories.
The report is intended to inform coding professionals, laboratory administrators, and transplant program stakeholders about the role of CPT code 86805 in practice, expected billing scenarios, and areas where policy updates or payer guidance commonly affect coverage and claim adjudication.
Billing Code Overview
CPT code 86805 describes an in‑vitro compatibility test in which a laboratory analyst mixes donor lymphocytes with recipient serum at increasing dilutions and microscopically observes for cell lysis. The presence of cell lysis indicates antibody‑mediated incompatibility relevant to transplant evaluation.
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Service type: Immunohematology / transplant compatibility testing
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Typical site of service: Hospital reference laboratory, hospital outpatient laboratory, or specialized immunology/transplant laboratory
Data not available in the input for associated taxonomies, ICD‑10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 52-year-old female with end-stage renal disease is evaluated before a planned kidney transplant from a living-related donor. Pre-transplant immunologic compatibility testing is ordered. In the clinical workflow, the transplant coordinator obtains donor and recipient blood samples and sends them to the histocompatibility laboratory. A clinical laboratory scientist or histocompatibility analyst performs the cell cytotoxicity crossmatch assay by mixing donor lymphocytes with serial dilutions of recipient serum, incubating, and microscopically observing for complement-mediated cell lysis. Results are reported to the transplant team to inform immunologic risk and guide donor selection and perioperative immunosuppression planning. Typical site of service is a hospital-based immunology/histocompatibility laboratory or an independent clinical reference laboratory supporting transplant programs. The service type is a specialized transplant compatibility immunology test (lymphocytotoxic crossmatch).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the professional (interpretation) component if the laboratory splits technical and professional components and the lab reports only interpretation. |
TC |