CPT 86812 HLA Class I Single Antigen — Reimbursement

CPT code 86812 represents a serologic laboratory test to identify a single human leukocyte antigen (HLA) Class I antigen—one of the A, B, or C antigens. This code captures single-antigen serologic HLA typing, a procedure used in immunogenetics for transplant compatibility assessment, disease association studies, and certain immunologic evaluations. Nationally, HLA testing matters for organ and tissue transplantation programs, immunology research, and specialized diagnostic workflows.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides an overview useful to clinical laboratory managers, billing and coding teams, and policy analysts.

Readers will learn the clinical context and typical service setting for CPT code 86812, common billing considerations, and where this service fits within laboratory and transplant care pathways. The report outlines payer coverage landscape at a national level, summarizes available benchmarks and utilization patterns when present, and highlights policy and coding updates that affect HLA serologic testing reimbursement and documentation. Data not available in the input will be explicitly noted in relevant sections.

Billing Code Overview

CPT code 86812 describes a serologic test to identify a single human leukocyte antigen (HLA) Class I antigen, detecting one or more of the major HLA Class I cell surface antigens: A, B, or C. The procedure involves laboratory analysis of a patient sample to determine the presence of a specific HLA antigen using serologic methods.

Service type: Laboratory serologic HLA typing (single antigen)

Typical site of service: Clinical laboratory or hospital laboratory

Data not available in the input.

Clinical Context

A 42-year-old patient undergoing evaluation for kidney transplantation is referred to the histocompatibility laboratory for HLA Class I antigen typing. The clinician orders a single-antigen serologic assay to determine whether the patient expresses a specific HLA-A, HLA-B, or HLA-C antigen that may affect donor compatibility or risk of sensitization. The typical workflow: the transplant coordinator obtains a blood sample and sends it to the hospital or reference immunogenetics laboratory; a medical technologist or lab analyst performs the serologic test using reagent antisera and microscopy or automated platforms; results are reviewed by a pathologist or HLA laboratory director and reported to the transplant team for donor selection and crossmatch planning. This service is commonly performed in an outpatient collection setting, hospital laboratory, or specialized reference immunogenetics laboratory and supports pre-transplant workup, organ allocation decisions, and transfusion or immunogenetics consultations.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the professional interpretation component provided by the pathologist or lab director.
`59`	Distinct procedural service

Taxonomy Code	Specialty	Notes
207RH0000X	Hematopathology	Pathologists who interpret immunogenetics and HLA serology.
350400000X	Clinical Laboratory	Clinical laboratory scientists/technologists performing serologic testing.
2080S0003X	Transplant Immunology	Specialists directing HLA testing and transplant compatibility services.
207L00000X	Anatomic and Clinical Pathology	Pathologists overseeing lab testing and result validation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z94.0`	Kidney transplant status	Used for pre-transplant workup or monitoring of transplant candidates/recipients requiring HLA typing.
`Z48.23`	Encounter for aftercare following organ transplant	Relevant when assessing compatibility or antibody monitoring post-transplant.
`Z52.4`	Donor of kidney for transplant	Relevant for typing of potential living donors to determine HLA compatibility.
`D47.Z9`	Other neoplasm of uncertain behavior of lymphoid, hematopoietic and related tissue	May be relevant when immunogenetic profiling is indicated during hematologic evaluations.
`T86.10`	Unspecified complication of kidney transplant	Used when investigating graft dysfunction where HLA-mediated rejection is a concern.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`86816`	HLA class II typing by serologic methods	Performed when additional HLA Class II antigen information is needed for donor-recipient matching.
`86813`	HLA class I typing, each additional antigen identified (when applicable)	Billed when multiple class I antigens are identified in addition to the primary antigen coded with `86812`.
`86825`	HLA crossmatch, lymphocyte (e.g., AHG)	Performed after HLA typing to assess recipient antibodies against donor lymphocytes for compatibility.
`86850`	HLA antibody identification by solid phase or other methods	Used to identify specific anti-HLA antibodies complementing serologic antigen typing in sensitized patients.
`86900`	Autoantibody, each procedure (screening methods)	May be performed in parallel when broader immunologic screening is indicated in transplant evaluation.

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Summary & Overview

CPT 86812: HLA Class I Single Antigen Serologic Test