Summary & Overview
CPT 86911: Blood Antigen Typing for Paternity Assessment
CPT code 86911 designates a specialized laboratory procedure for typing blood antigens outside the ABO, Rh, and MN systems specifically to assess likelihood of paternity. This narrowly focused immunohematology test is relevant in medico-legal and family-relationship contexts and can influence legal, forensic, and clinical determinations. Nationally, such procedures are performed by hospital and reference clinical laboratories with expertise in advanced serologic methods.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical intent and service context, typical sites of service, common billing modifiers and their presence in claims (where available), and how this code aligns with laboratory service lines. The publication also covers reimbursement benchmarking, coding considerations, and payer coverage patterns that affect billing for specialized paternity antigen typing. Where input data is incomplete, the report notes those gaps as "Data not available in the input." The content is written for a national audience and focuses on operational and policy-relevant implications for laboratories, billing professionals, and compliance teams.
Billing Code Overview
CPT code 86911 describes a laboratory test in which the analyst types blood under an antigen system other than ABO, Rh, or MN for the purpose of establishing the likelihood of paternity. This service is a specialized immunohematology procedure focused on antigen typing outside the common blood group systems.
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Service type: Paternity-focused immunohematology blood antigen typing
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Typical site of service: Clinical laboratory or hospital laboratory setting where specialized serologic testing is performed
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Clinical & Coding Specifications
Clinical Context
A 28-year-old mother and a 31-year-old alleged father present to a forensic blood bank laboratory to establish paternity for medicolegal purposes. A phlebotomy technician collects peripheral blood samples from both parties and the child, labels specimens with unique identifiers, and completes chain-of-custody documentation. The laboratory analyst performs specialized blood antigen typing under a non-ABO, non-Rh, non-MN antigen system (for example, Kell, Duffy, Kidd, or Lutheran) using validated serologic or molecular methods to compare antigen profiles among the trio. Results are interpreted to determine the likelihood of paternity and reported in a formal paternity report. Typical site of service is an outpatient reference or hospital clinical laboratory performing forensic or genetic-type testing. The procedure is often requested with documentation indicating legal paternity testing, may require strict specimen handling and custody forms, and is billed under the forensic blood-type testing service described by 86911.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Append when only the professional interpretation/reporting component is billed separately from the laboratory technical component. |