2025 CPT code 86790
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Laboratory - Immunology Procedures Pathology and Laboratory Feed
Antibody test for an unspecified virus.
Modifiers may be applicable, depending on the circumstances and payer requirements.Consult the CPT codebook and payer-specific guidelines for appropriate modifier use. Example: Modifier 90 for testing performed at an outside lab.
Medical necessity for 86790 is established when clinical suspicion of viral infection exists, and no other specific CPT code exists for the virus in question.Documentation supporting this must be provided to justify the use of this unlisted code.
Clinical laboratory personnel perform the immunoassay, analyze the results, and report findings to the ordering physician.
In simple words: This lab test checks your blood for antibodies to a virus that doesn't have its own specific lab test code.Finding antibodies means you've been exposed to or are fighting off a particular virus.
This CPT code, 86790, reports the performance of an immunoassay to detect antibodies against a virus not otherwise specified in the CPT codebook.The test involves analyzing a patient sample (typically serum) to identify the presence of viral antibodies, indicating prior exposure or an active immune response to a particular viral infection.This is utilized when no other specific CPT code exists for the target virus.
Example 1: A patient presents with symptoms suggestive of a viral infection, but standard tests do not identify a known pathogen.An antibody test using code 86790 may be performed to identify past or current exposure to a less common virus., A patient requires antibody testing for a newly emerging virus, for which a specific CPT code has not yet been assigned. Code 86790 would be used in this scenario, with detailed documentation supporting the medical necessity and the nature of the test performed., During epidemiological investigations of an outbreak of an unknown viral illness, code 86790 might be used for antibody testing on patient samples to detect the presence of specific antibodies to help identify the causative agent.
* Patient demographics and relevant clinical history.* Detailed description of the virus (or viral family) for which antibodies are being tested.* Justification for using 86790 due to the absence of a specific CPT code.* Lab report with test results and interpretations.* Copies of relevant medical records and documentation supporting the need for this unlisted procedure.
** Careful documentation is critical when using unlisted CPT codes, as claims may be denied without sufficient justification and supporting clinical evidence.Always verify payer-specific coverage and billing requirements before submitting a claim using this code.
- Revenue Code: T1H (LAB TESTS - OTHER)
- RVU: Refer to CMS relative value units (RVUs) and local payer fee schedules for specific reimbursement amounts.These values will vary based on geographic location and payer.
- 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 : Historical fee schedules vary by payer and location; consult payer-specific fee schedules and local prevailing charges for accurate historical data.
- Specialties:Infectious Disease, Clinical Microbiology, Virology, Pathology
- Place of Service:Office, Hospital outpatient, Laboratory