CPT 86830 HLA Class I Antibody — Reimbursement

Headline: CPT code 86830: Solid-phase HLA Class I Antibody Immunoassay — laboratory test with transplant and alloimmunization implications

CPT code 86830 denotes a solid-phase immunoassay performed on patient serum to detect antibodies to HLA Class I antigens. This laboratory procedure is central to transplant compatibility testing and to identifying alloimmune responses in patients with prior sensitizing events. Nationally, the test informs clinical decision-making in transplant listing, donor selection, and post-transplant monitoring, and it intersects with payer coverage policies for advanced immunogenetics.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise summary of clinical context for the assay, typical sites of service where the test is performed, and which payers commonly cover laboratory immunology services. The publication presents benchmark considerations for utilization, common billing modifiers and service-line placement, and notes where data were not provided.

This summary equips laboratory managers, transplant program administrators, and billing professionals with a clear understanding of CPT code 86830, its clinical role, and the payer landscape relevant to national coverage and billing practice.

Billing Code Overview

CPT code 86830 describes a solid phase immunoassay performed on patient serum to detect antibodies against HLA Class I antigens. The assay identifies the presence of specific antibodies directed at a panel of complete HLA Class I phenotypes.

Service type: Laboratory immunology testing

Typical site of service: Clinical laboratory or hospital lab

Data not available in the input.

Clinical Context

A 45-year-old patient with end-stage renal disease is evaluated for kidney transplantation. The transplant program orders antibody screening for donor-specific HLA Class I antibodies prior to listing and again during donor workup. A phlebotomy technician collects a serum sample which is sent to the laboratory. A medical laboratory scientist performs a solid-phase immunoassay using patient serum to detect antibodies to HLA Class I antigens from a complete panel of Class I phenotypes, documenting antibody specificity and strength. Results are reported to the transplant physician and transplant immunology team to guide donor selection, crossmatching decisions, and immunosuppression planning. Typical site of service is an outpatient clinical laboratory or hospital-based immunology lab performing specialized transplant testing.

Coding Specifications

Modifier	Description	When to Use
`00`	Unspecified	Rarely used; not recommended for routine reporting of this laboratory service
`11`	Professional component	Use when reporting the professional component (interpretation) separately from technical staging if applicable in mixed charge reporting

Taxonomy Code	Specialty	Notes
207R00000X	Pathology	Medical directors and pathologists who interpret complex immunologic testing
372B00000X	Clinical Laboratory	Clinical laboratory scientists and laboratory directors overseeing testing operations
2083P0200X	Allergy & Immunology	Specialists who may request and interpret HLA antibody testing in transplant immunology contexts
208000000X	Internal Medicine	Transplant physicians, nephrologists coordinating pre-transplant testing
2084P0800X	Nephrology	Nephrologists managing patients undergoing kidney transplant evaluation

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z94.0`	Kidney transplant status	Relevant for post-transplant monitoring and HLA antibody testing to evaluate graft compatibility or rejection risk
`N18.6`	End stage renal disease	Primary indication for kidney transplant evaluation and pre-transplant HLA antibody screening
`Z48.21`	Encounter for aftercare following kidney transplant	Used when performing HLA antibody testing during routine post-transplant follow-up
`T86.10`	Kidney transplant failure and rejection, unspecified	HLA antibody testing is used when rejection is suspected to identify donor-specific antibodies
`Z01.82`	Encounter for preprocedural laboratory examination	Used during transplant workup when HLA antibody screening assays are ordered

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`86830`	The lab analyst performs a solid phase immunoassay using patient serum to identify the presence of specific antibodies to specific Class I human leukocyte antigens, or HLA, from a panel of complete HLA Class I phenotypes.	Primary assay for detecting HLA Class I antibodies in transplant evaluation
`86850`	The lab analyst performs a solid phase immunoassay using patient serum to identify the presence of specific antibodies to HLA Class II antigens from a panel of complete HLA Class II phenotypes.	Often performed alongside `86830` to assess Class II HLA antibodies for comprehensive donor compatibility assessment
`86816`	Crossmatch by anti-human globulin (AHG) enhanced complement-dependent cytotoxicity (CDC) technique.	Performed in some transplant programs to assess donor-specific reactivity; complements solid-phase antibody testing
`86860`	HLA specific antibody identification, single antigen bead testing, per antigen.	Used when more granular single antigen specificity and strength information is required following screening assays like `86830`
`86465`	Antibody; HIV-1 and HIV-2, confirmatory by Western blot, or other confirmatory testing.	Example of laboratory confirmatory testing workflow; not specific to HLA but illustrates specialized serologic testing performed in reference labs

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Summary & Overview

CPT 86830: HLA Class I Antibody Solid-Phase Immunoassay