Summary & Overview
CPT 86813: HLA Class I Serologic Antigen Typing
CPT code 86813 represents serologic testing for multiple human leukocyte antigens (HLA) within HLA Class I (A, B, and C) and is used to identify antigen specificities for clinical and transplant-related decision-making. Nationally, HLA typing supports organ and tissue matching, transfusion planning, and certain immunogenetics evaluations; accurate coding ensures appropriate laboratory claims and downstream clinical workflows. This publication covers commercial and government payers commonly involved in laboratory reimbursement: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise explanation of what CPT code 86813 denotes, typical settings where the service is performed, and the clinical relevance of HLA Class I serologic assays. The analysis highlights payer coverage considerations and common modifiers encountered on laboratory claims. It also outlines benchmarks and policy developments relevant to HLA testing reimbursement and situates CPT code 86813 in the broader laboratory service line context. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 86813 describes a laboratory serologic test to identify multiple human leukocyte antigens (HLA) from one or more of the three major HLA Class I cell surface antigen types: A, B, and C. The procedure entails an analyst performing serologic assays to detect HLA Class I antigen specificities from a patient specimen.
Service Type: Laboratory serologic HLA Class I typing
Typical Site of Service: Clinical laboratory or hospital laboratory setting, where trained laboratory personnel perform serologic HLA testing on blood or tissue specimens.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 42-year-old patient with end-stage renal disease is being evaluated for kidney transplantation. The transplant team orders HLA Class I antigen typing to determine the patient's HLA-A, HLA-B, and HLA-C antigen profile to assist in donor-recipient matching and crossmatch interpretation. Peripheral blood is drawn in the outpatient lab or transplant clinic and sent to the histocompatibility laboratory. A histocompatibility technologist or lab analyst performs serologic testing using validated reagents and techniques to identify HLA Class I antigens. Results are reported to the transplant coordinator and transplant immunology physician and entered into the electronic medical record to guide donor selection, virtual crossmatch, and post-transplant immunologic risk assessment. Typical sites of service include hospital-based histocompatibility labs, independent reference immunogenetics laboratories, and transplant center laboratories.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Standard primary procedure code | Not commonly used as a billing modifier; appears in modifier lists as default. |
11 | Office or outpatient visit (not a modifier in CMS lists but included in raw data) |