2025 CPT code 86628
(Active) Effective Date: N/A Revision Date: N/A Pathology and Laboratory Procedures - Qualitative or Semiquantitative Immunoassays Immunology Procedures Feed
This CPT code reports a multi-step qualitative or semiquantitative immunoassay to detect Candida antibodies in a patient's serum.
Modifiers such as 91 (repeat test) or 59 (distinct procedural service) may be applicable depending on payer requirements and the circumstances under which the test is performed. Consult payer guidelines for specific modifier usage rules.
The medical necessity for this test is determined by the clinical suspicion of Candidiasis based on the patient's signs and symptoms.The results of this test, combined with other clinical findings, assist in the diagnosis and management of the condition.
The clinical responsibility lies with the laboratory analyst who performs the technical aspects of the immunoassay, including specimen preparation, antigen reaction, incubation, detection, and result interpretation. The ordering physician is responsible for medical decision-making based on the results in the context of patient history and other diagnostic information.
In simple words: This lab test checks a blood sample for antibodies against a type of fungus called Candida.The test helps doctors diagnose candidiasis, a fungal infection that can affect different parts of the body.The results show if antibodies are present and at what level.
CPT code 86628 represents a multi-step qualitative or semiquantitative immunoassay used to detect Candida antibodies in a patient's serum.The procedure involves several steps: reacting the specimen with test antigens, incubating the mixture, adding a detection agent (e.g., stain or fluorescent marker), and interpreting the results (positive, negative, or semi-quantitative value).Clinicians may order this test to assist in diagnosing Candidiasis, an opportunistic infection caused by yeasts like Candida albicans.The test can be performed for different immunoglobulin classes (IgG, IgM, IgA) and Candida species.Note that elevated antibody levels may not always indicate Candidiasis, requiring additional tests (culture, antigen detection) billed separately.This code is not used for antigen detection or single-step methods like reagent strip tests.
Example 1: A patient presents with symptoms suggestive of oral thrush (candidiasis). The physician orders an immunoassay (86628) to detect Candida antibodies (IgG, IgM, IgA) in the serum to support the diagnosis., An immunocompromised patient develops a systemic fungal infection.The physician orders a panel of Candida antibody tests (86628) for IgG, IgM, and IgA to evaluate the extent of the infection and guide treatment., A pregnant woman with vaginal yeast symptoms undergoes testing. The physician orders an 86628 test for Candida albicans antibodies to aid in the diagnosis and appropriate treatment plan.
** This code should only be used for multi-step tests.Always verify payer-specific coverage and coding guidelines prior to billing.
- Revenue Code: T1H (LAB TESTS - OTHER (NON-MEDICARE FEE SCHEDULE))
- RVU: Information not available in provided source. Refer to CMS fee schedules for current RVU values.
- 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 procedure.
- Fee Schedule: Information not available in provided source. Consult historical CPT fee schedules and payer-specific data for historical reimbursement information.
- Specialties:Clinical Microbiology, Infectious Disease, Immunology, Pathology
- Place of Service:Laboratory