CPT 86816 HLA Class II Typing Reimbursement

CPT code 86816 designates a serologic laboratory test that identifies a single human leukocyte antigen (HLA) specificity within HLA Class II, focused on the DR and DQ loci. This code is used for targeted HLA typing in clinical contexts such as transplant matching, immunogenetics, and diagnostic evaluation of immune-mediated conditions. Nationally, accurate reporting of HLA testing codes supports care coordination for transplantation and establishes clinical documentation for payer adjudication.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise summary of the clinical context for CPT code 86816, typical sites of service, and the types of information payers commonly consider for laboratory HLA testing claims.

This publication provides benchmarks and policy-relevant context rather than clinical guidance. It outlines typical utilization contexts, common modifiers used with laboratory procedures (listed elsewhere in the document), and highlights areas where payers may request medical necessity documentation. Data not provided in the input, such as associated taxonomies, ICD-10 diagnoses, and payer-specific coverage edits, are noted as unavailable in the relevant sections.

Billing Code Overview

CPT code 86816 describes a serologic test to identify a single human leukocyte antigen (HLA) from HLA Class II cell surface antigens, specifically the DR and DQ loci. The procedure involves laboratory analysis to detect one HLA specificity using serologic methods.

Service type: Laboratory — HLA Class II serologic typing (single antigen, DR or DQ)

Typical site of service: Clinical laboratory or hospital pathology service (inpatient or outpatient lab setting)

Clinical Context

A 42-year-old patient with end-stage renal disease is being evaluated for kidney transplantation. The transplant center orders HLA Class II typing focused on DR and DQ loci to identify recipient HLA antigens for donor-recipient matching and crossmatch interpretation. A phlebotomy technician obtains a blood sample in an anticoagulated tube and sends it to the immunogenetics laboratory. The laboratory analyst performs a serologic HLA Class II test for one or more DR and/or DQ specificities using standard microlymphocytotoxicity or flow-based serologic methods; results are reported to the transplant team and entered into the laboratory information system. The workflow includes specimen accessioning, cell separation or preparation, performance of the serologic assay, quality control, interpretation by a qualified laboratory professional, and issuance of a final report that feeds into donor selection and anti-HLA antibody assessment.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when only the professional (interpretation) component is billed separately from the technical component.
`TC`	Technical component	Use when only the technical component (lab processing and testing) is billed.

Taxonomy Code	Specialty	Notes
207RH0000X	Hematopathology	Pathologists and laboratory physicians who may supervise and interpret HLA testing.
207L00000X	Clinical Laboratory	Clinical laboratory scientists and directors responsible for technical performance of immunogenetics testing.
2080P0004X	Transplant Immunology	Specialists in immunogenetics and HLA laboratory medicine involved in transplant testing.
2083P0200X	Nephrology	Ordering clinicians who request HLA typing for kidney transplant candidates.
207M00000X	Anatomic and Clinical Pathology	Pathology specialists overseeing serologic and molecular HLA testing.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z94.0`	Kidney transplant status	Used for transplant recipients where HLA typing guides donor selection and post-transplant immunologic assessment.
`Z48.21`	Encounter for aftercare following kidney transplant	Relevant when monitoring for rejection and evaluating HLA compatibility or antibody surveillance.
`N18.6`	End stage renal disease	Common diagnosis in patients undergoing pre-transplant HLA typing.
`Z52.4`	Donation of kidney (living donor)	Donor HLA typing for compatibility with intended recipient.
`T86.12`	Kidney transplant rejection	HLA typing and antibody testing assist in evaluation of suspected rejection.
`Z94.1`	Heart transplant status	HLA typing may be required for other solid organ transplants where class II typing is relevant.
`Z48.21`	Encounter for aftercare following kidney transplant	Repeated for emphasis in post-transplant immunologic evaluations.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`86816`	HLA serologic typing for one HLA Class II antigen (DR or DQ)	Primary procedure: identification of a single HLA Class II antigen (DR or DQ) by serologic methods.
`86810`	HLA serologic typing, class I (A, B)	Performed alongside class II typing to provide a full HLA profile for transplant matching when class I antigens are required.
`86830`	HLA molecular typing, each locus (example: DRB1)	Molecular methods (PCR-based) often performed in addition to or as confirmatory testing to serologic class II typing.
`86900`	Antibody screening; platelet or red cell antibody screen (single or multiple antigen)	Performed to assess recipient alloantibodies that may affect transplant compatibility and crossmatch interpretation.
`86860`	Crossmatch, lymphocyte (direct or indirect)	Direct crossmatch testing between donor lymphocytes and recipient serum is used after HLA typing to determine immunologic compatibility.
`86353`	Antibody detection by indirect immunofluorescence or other technique	Used for detection of anti-HLA antibodies complementing serologic typing results.

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Summary & Overview

CPT 86816: HLA Class II Serologic Typing, Single Antigen (DR or DQ)