Summary & Overview
CPT 86941: Test for Auto‑agglutinins and Auto‑hemolysins
CPT code 86941 denotes a laboratory serologic procedure that tests patient blood for auto‑agglutinins and auto‑hemolysins, detecting factors that cause red blood cells to clump or undergo hemolysis. This diagnostic assay is used in the evaluation of suspected immune‑mediated hemolytic anemia and related hematologic disorders, making it clinically relevant across inpatient and outpatient laboratory settings nationwide. The code matters because accurate identification of immune‑mediated red cell disorders influences clinical management, transfusion decisions, and downstream utilization of specialized hematology services.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical purpose of the test, the typical sites where the service is performed, and the kinds of billing considerations associated with laboratory serology. The publication also covers coding context, common modifiers in practice (listed separately), and national policy considerations that affect laboratory billing and coverage. Where specific data elements were not provided in the input, the report notes that those items are not available and focuses on interpretation of the code, clinical context, and payer relevance for a national audience.
Billing Code Overview
CPT code 86941 describes laboratory testing for auto‑agglutinins and auto‑hemolysins, in which a laboratory analyst incubates patient blood with specified additives to detect factors that cause red blood cells to clump or rupture. This is a serological diagnostic test used to evaluate immune‑mediated hemolytic processes and related hematologic conditions.
Service type: Laboratory diagnostic testing (serology)
Typical site of service: Clinical laboratory or hospital laboratory
Clinical & Coding Specifications
Clinical Context
A 48-year-old patient presents to the hematology clinic with signs of unexplained anemia and a history of dark urine and jaundice. Laboratory evaluation shows a falling hemoglobin over several days and a positive direct antiglobulin (Coombs) screen. The clinician orders serologic testing to characterize warm and cold autoantibodies. In the clinical workflow, a phlebotomy technologist collects a blood specimen and sends it to the hospital immunohematology laboratory. A lab analyst performs 86941 to detect auto‑agglutinins and auto‑hemolysins by incubating patient serum with red cells under specified conditions and additives (for example, various temperatures or reagents) to evaluate for immune‑mediated hemolysis. Results are reviewed by a clinical laboratory scientist and reported to the ordering hematologist, who integrates findings with the direct antiglobulin test, peripheral smear, and hemolysis markers (LDH, bilirubin, haptoglobin) to guide diagnosis and therapy.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation component separated from the technical laboratory work. |
TC |