Summary & Overview
CPT 86806: Serologic Crossmatch for Transplant Compatibility
CPT code 86806 represents a serologic crossmatch test in which donor lymphocytes are combined with recipient serum and microscopically observed for cell lysis to detect transplant incompatibility. This pre-transplant immunology assay is critical for identifying antibody-mediated risks that can lead to graft failure or immediate rejection, making it a key diagnostic step in solid organ and hematopoietic stem cell transplantation workflows nationwide.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a national overview useful to hospital laboratories, transplant programs, and billing professionals.
Readers will find a concise explanation of the clinical context and service setting for CPT code 86806, an outline of common billing and coding considerations, and a summary of benchmarks and policy-relevant points where available. The report summarizes typical sites of service and the clinical rationale for testing, and it identifies areas where input data is not provided. Data not available in the input will be noted explicitly in the appropriate sections.
Billing Code Overview
CPT code 86806 describes a laboratory compatibility test in which donor lymphocytes are mixed with recipient serum and observed microscopically for cell lysis, indicating potential transplant incompatibility. This is a serologic crossmatch procedure performed by a laboratory analyst to assess immunologic compatibility between donor and recipient prior to transplantation.
Service type: Immunology / Transfusion Medicine Diagnostic Test
Typical site of service: Hospital laboratory or independent clinical laboratory (specialty transplant laboratory)
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 48-year-old male with end-stage renal disease is being evaluated for a living-donor kidney transplant. The transplant team orders a crossmatch to assess immunologic compatibility between the prospective donor and recipient. The laboratory receives a sample of donor lymphocytes and recipient serum. The lab analyst performs a complement-dependent cytotoxicity crossmatch by mixing donor lymphocytes with recipient serum, incubating with complement, and microscopically observing for cell lysis. A positive cytotoxic reaction indicates preformed recipient antibodies against donor HLA and suggests transplant incompatibility, which informs organ allocation and immunosuppression planning. Typical workflow steps include sample collection and labeling, specimen accessioning, cell preparation, performing the cytotoxicity assay, microscopic read and documentation, and result reporting to the transplant clinician and transplant coordinator.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Office or other outpatient service as the professional component | Use when reporting the professional component is separately identified and performed by the billing physician or laboratorian interpreting the assay. |
26 | Professional component |