2025 CPT code 86701
(Active) Effective Date: N/A Pathology and Laboratory Procedures - Immunology Procedures Feed
Antibody; HIV-1
Yes. Modifiers such as 59 (Distinct Procedural Service), 90 (Reference (Outside) Laboratory), 91 (Repeat Clinical Diagnostic Laboratory Test), and 92 (Alternative Laboratory Platform Testing) may be applicable depending on the circumstances of the test performance.
Medical necessity is determined by the patient's risk factors, symptoms, or clinical presentation suggesting a potential HIV infection.The test can be used for diagnosis, screening, or monitoring.
The lab analyst performs the technical aspects of the test, including reacting the specimen, incubation, adding detection agents, and interpreting the results. Clinicians order the test for diagnosis, risk assessment, or symptom management related to HIV-1.
In simple words: This test checks your blood for HIV-1 antibodies. Antibodies are produced by your body when you're exposed to the virus.This test helps determine if you have been infected with HIV-1.
This code represents a qualitative or semiquantitative immunoassay for the detection of HIV-1 antibodies in a patient's serum.The test helps diagnose or rule out HIV-1 infection, the virus that causes AIDS.It is performed by a lab analyst using methods like enzyme immunoassays (EIA), reacting the specimen with test antigens, incubating, adding a detection agent (stain, fluorescent marker, etc.), and interpreting the results (positive, negative, or semiquantitative value).
Example 1: A patient with risk factors for HIV, such as intravenous drug use, undergoes routine HIV screening., A patient presents with symptoms suggestive of HIV infection, such as weight loss, recurrent fever, or swollen lymph nodes, and the test is ordered for diagnostic purposes., A pregnant woman is tested for HIV as part of routine prenatal care.
Documentation should include the reason for testing, patient consent (if required), the specific test performed, the results, and any relevant clinical findings.
** While specimen collection codes like 36415 may be reported separately by some payers, it is often included in the 86701 code. Modifier 92 might be applicable for tests performed using alternative lab platforms.
- Revenue Code: T1H (LAB TESTS - OTHER (NON-MEDICARE FEE SCHEDULE))
- Specialties:Infectious Disease, Internal Medicine, Family Medicine, Obstetrics/Gynecology, Public Health
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Independent Laboratory, Public Health Clinic, and other applicable facilities.