2025 CPT code 86403
(Active) Effective Date: N/A Revision Date: N/A Laboratory - Immunology Procedures Pathology and Laboratory Procedures Feed
Particle agglutination screen, each antibody.
Modifiers 26 (professional component) and TC (technical component) may be applicable depending on the service provided by the physician and the lab. Modifiers 90 (reference lab) and 91 (repeat test) may also apply in certain situations. Consult the current CPT guidelines for appropriate modifier use.
Medical necessity is established when the physician documents a clinical indication for the test, such as evaluating a patient's immune status, diagnosing an autoimmune disorder, monitoring the response to treatment, or assessing for incompatibility during pregnancy.Supporting clinical documentation is required for reimbursement.
The ordering physician is responsible for determining the medical necessity of the test. The laboratory performs the technical aspects of the test and reports the results back to the physician. The physician interprets the results and discusses them with the patient.
In simple words: This blood test checks for specific antibodies in your blood by looking for clumps of cells.It helps doctors understand your immune system and identify certain illnesses.
This CPT code 86403 represents a particle agglutination (PA) test performed on a patient specimen, typically blood, to screen for the presence of specific antibodies. The test involves mixing the patient specimen with specific antigen reagents, causing antibody-antigen complexes to form and agglutinate (clump).The test assays concentrations of a specific antigen, determining the presence and amount of antibodies.Reporting requires considering multiple antibodies or titers and separate venipuncture/blood draw codes.
Example 1: A patient presents with symptoms suggestive of an autoimmune disease. The physician orders a particle agglutination test to screen for various autoantibodies., A pregnant woman undergoes a particle agglutination test to screen for antibodies that may indicate incompatibility with the fetus (e.g., Rh antibodies)., A patient with a history of recurrent infections is tested for specific antibody deficiencies using particle agglutination.
Physician's order specifying the test(s) to be performed, patient demographics, date of service, test results, and interpretation by the physician.
** This test is subject to Clinical Laboratory Improvement Amendments (CLIA) regulations.Always check for payer-specific requirements and coding conventions.
- Revenue Code: T1H (LAB TESTS - OTHER)
- RVU: This information is not available in the provided source.Consult the current CPT codebook or other relevant resources for RVU information.
- Payment Status: Active
- Modifier TC rule: This code may include a technical component (TC) and a professional component (26).
- Fee Schedule: The provided data does not include a historical fee schedule.Refer to historical CPT fee schedules for this information.
- Specialties:Immunology, Rheumatology, Hematology, Obstetrics and Gynecology, Infectious Disease
- Place of Service:Office, Hospital, Clinical Laboratory, Ambulatory Surgical Center