2025 CPT code 86317
(Active) Effective Date: N/A Revision Date: Oct 1, 2020 Pathology and Laboratory Procedures - Qualitative or Semiquantitative Immunoassays Immunology Procedures Feed
Quantitative immunoassay for infectious agent antibodies; not otherwise specified.
Modifiers may be applicable depending on the place of service, the type of laboratory, and other factors. Consult the NCCI edits for applicable modifiers.
Medical necessity for code 86317 is established when the physician orders the test based on the patient's clinical presentation, symptoms, and suspected diagnosis.The results are needed to confirm or refute a diagnosis, guide treatment decisions, and/or monitor disease progression. The test must be appropriate given the patient's condition.
The clinical responsibility lies with the laboratory personnel who perform the technical aspects of the immunoassay, including specimen handling, assay execution, and result interpretation. The ordering physician is responsible for medical decision-making based on the test results.
In simple words: This lab test measures the amount of antibodies to a specific infection in your blood or other body fluid.The test uses special methods to detect and measure these antibodies to help diagnose an infection. This test is used when there isn't a more specific test for the infection.
This CPT code reports a quantitative immunoassay used to measure the level of antibodies against an infectious agent in a patient's specimen (e.g., blood, serum, or body fluid).The assay is not otherwise specified by a more specific code within the CPT code set.Techniques may include enzyme-linked immunosorbent assays (ELISA) or similar methods involving antigen-antibody reactions, incubation, detection using markers (e.g., fluorescent tags), and quantitative result interpretation.This code is only used when no more specific code exists for the particular infectious agent antibody being measured.
Example 1: A patient presents with symptoms suggestive of a viral infection (e.g., fever, fatigue, muscle aches). The physician orders a quantitative immunoassay (86317) to measure the level of antibodies specific to a suspected virus to confirm the diagnosis and monitor disease progression., A patient is undergoing regular monitoring for a chronic infectious disease. The physician orders serial quantitative immunoassays (86317) to track the patient's antibody response to treatment and evaluate the effectiveness of the therapy., During an outbreak of an emerging infectious disease, a public health laboratory utilizes a quantitative immunoassay (86317) to measure antibody levels in population samples to assess the prevalence and spread of the infection.
* Patient demographics and relevant medical history.* Physician's order specifying the requested test.* Specimen collection details (date, time, type of specimen, collection method).* Complete lab report including quantitative results, methodology, and interpretation.* Supporting clinical documentation demonstrating medical necessity (e.g., patient symptoms, clinical findings).
** The accuracy of coding with 86317 hinges on detailed clinical documentation supporting the medical necessity of the test.Always refer to the most recent CPT codebook and payer guidelines for the most up-to-date information.
- Revenue Code: T1H (LAB TESTS - OTHER)
- RVU: This information requires consultation with the specific payer's fee schedule.RVUs vary based on geographic location, facility type (e.g., hospital, clinic), and other factors.
- Global Days: Not applicable. This is a laboratory test, not a surgical procedure.
- Payment Status: Active
- Modifier TC rule: Not applicable.This is a complete laboratory test.
- Fee Schedule: This information varies significantly by payer, location, and time period. It's advisable to consult fee schedules from the relevant payer.
- Specialties:Infectious Disease, Internal Medicine, Pathology, Microbiology, Immunology, Public Health
- Place of Service:Office, Hospital (Inpatient or Outpatient), Clinical Laboratory, Public Health Laboratory