Summary & Overview
CPT 86831: HLA Class II Antibody Solid Phase Immunoassay
CPT code 86831 represents a laboratory solid phase immunoassay that detects patient serum antibodies against HLA Class II antigens using a panel of complete Class II phenotypes. This test plays a crucial role in transplant medicine and immune monitoring by identifying donor-specific and other anti-HLA Class II antibodies that influence organ allocation, crossmatching decisions, and post-transplant surveillance. Nationally, availability and coverage of advanced histocompatibility testing affect transplant program workflows and patient management.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for HLA Class II antibody testing, typical sites of service and laboratory workflows, and payer coverage considerations. The publication summarizes common modifiers used with laboratory billing, notes on coding practice, and where to find supporting documentation for medical necessity.
The content provides operational benchmarks and policy-relevant points for administrators, laboratory directors, and billing staff who manage histocompatibility testing. Data not available in the input is clearly noted where applicable. The focus is national in scope and intended to clarify the clinical purpose and billing context for CPT code 86831.
Billing Code Overview
CPT code 86831 describes a solid phase immunoassay performed on patient serum to detect specific antibodies to HLA Class II antigens using a panel of complete HLA Class II phenotypes. This test identifies the presence of anti-HLA Class II antibodies that can be relevant in transplant evaluation, antibody-mediated rejection monitoring, and immunologic risk assessment.
Service Type: Laboratory — Immunology / Histocompatibility Testing
Typical Site of Service: Clinical laboratory or hospital-based immunology/histocompatibility laboratory
Clinical & Coding Specifications
Clinical Context
A 42-year-old woman with end-stage renal disease is being evaluated for kidney transplantation. The transplant team orders HLA Class II antibody testing to detect recipient antibodies against donor HLA-DR, -DQ, and -DP antigens. A phlebotomy specimen of patient serum is collected in the outpatient transplant clinic and sent to the immunology laboratory. A lab analyst performs a solid-phase immunoassay (CPT 86831) using a panel of complete HLA Class II phenotypes to identify specific anti-HLA Class II antibodies. Results are reported to the transplant coordinator and transplant nephrologist to inform donor selection and crossmatch planning. The typical workflow includes specimen receipt and accessioning, serum separation, testing on the solid-phase platform, data review by a qualified technologist, and electronic reporting to the electronic health record and transplant database. Typical sites of service are hospital clinical laboratories, freestanding reference immunology laboratories, and transplant center laboratories.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation component performed by a physician or qualified professional who interprets test results. |