Summary & Overview
CPT 86940: Screening for Auto‑agglutinins and Auto‑hemolysins
CPT code 86940 denotes a laboratory screening test for auto‑agglutinins and auto‑hemolysins — serologic factors that cause red blood cells to clump or hemolyze. This test is clinically relevant for evaluating suspected autoimmune hemolytic anemia and other immune‑mediated red cell disorders. Nationally, its use informs diagnostic workups in inpatient and outpatient settings and affects laboratory workflow and reimbursement policies.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical indications and typical settings, benchmarking context where available, and summaries of payer coverage approaches and policy considerations relevant to laboratory diagnostics. The publication highlights how coverage policies and coding practices intersect with clinical pathways for hemolytic disorders, providing context for clinicians, laboratory managers, and billing professionals.
The report covers practical elements such as common billing modifiers and service contexts, notes gaps where specific payer guidance is not available, and offers a national perspective on utilization and policy trends for serologic screening in autoimmune hemolysis evaluation.
Billing Code Overview
CPT code 86940 describes laboratory screening of a patient's blood for auto‑agglutinins and auto‑hemolysins — circulating factors that cause red blood cells to clump together or to rupture. The procedure typically involves serologic testing performed by a clinical laboratory analyst or technologist to detect immune‑mediated hemolytic processes or other autoantibody activity affecting red blood cells.
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Service type: Laboratory serologic screening
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Typical site of service: Clinical laboratory or hospital pathology/laboratory department
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Clinical & Coding Specifications
Clinical Context
A 52-year-old patient with progressive jaundice and a history of autoimmune disease presents to the outpatient laboratory and hematology clinic for evaluation of suspected autoimmune hemolytic anemia. The clinician orders a serologic evaluation for autoagglutinins and auto-hemolysins. A phlebotomy technician collects a peripheral blood sample and forwards it to the clinical laboratory. A medical laboratory technologist performs the screening procedure described by 86940, assessing patient serum for cold and warm autoagglutinins and for auto-hemolytic activity using standard hemolysin assays. Results are reported to the ordering clinician and documented in the electronic health record; positive findings trigger further confirmatory testing (for example, direct antiglobulin testing) and guide transfusion planning or immunosuppressive therapy decisions. Typical sites of service include hospital outpatient laboratories, independent clinical laboratories, and inpatient hospital laboratories where transfusion medicine and hematology consults are managed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the professional (interpretive) component of the test is reported separately from the technical component. |