2025 CPT code 86804
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Laboratory - Immunology Procedures Pathology and Laboratory Procedures Feed
Confirmatory Hepatitis C antibody test (e.g., immunoblot).
Modifiers may apply depending on the specific circumstances of the service.Examples include modifiers for the place of service and for repeat testing.Consult current modifier guidelines.
Medical necessity is established when there is clinical suspicion of Hepatitis C infection based on the patient's risk factors, symptoms, or prior positive screening test. The confirmatory test helps to ensure accurate diagnosis and guide treatment decisions.
The clinical responsibility lies with the laboratory analyst who performs the technical aspects of the test, including electrophoresis, blotting, and visualization techniques. The ordering physician interprets the results to assist in diagnosis.
- Pathology and Laboratory Procedures
- Immunology Procedures; Qualitative or Semiquantitative Immunoassays
In simple words: This lab test checks for antibodies to Hepatitis C in your blood. It's a more precise test used to confirm a previous positive Hepatitis C antibody test.The test helps doctors confirm if you have a Hepatitis C infection.
CPT code 86804 represents a confirmatory immunoassay for the detection of antibodies to Hepatitis C virus (HCV).This test typically employs methods such as immunoblot (Western blot) to confirm a previous positive HCV antibody screening test. The procedure involves separating HCV antigens using electrophoresis, transferring them to a membrane, and then incubating with the patient's serum.The presence of HCV antibodies is detected through a visualization method, often using a dye. This test is crucial for definitively diagnosing HCV infection.
Example 1: A patient presents with symptoms suggestive of Hepatitis C. An initial screening test is positive. Code 86804 is used to confirm the presence of HCV antibodies through a confirmatory immunoblot., A patient with a history of intravenous drug use undergoes routine Hepatitis C antibody testing. The initial test is positive. Code 86804 is performed to confirm the diagnosis and guide treatment., A pregnant woman screens positive for HCV antibodies.Code 86804 is used to verify the infection status before and during pregnancy, informing appropriate management strategies.
* Patient demographics and medical record number.* Physician's order specifying the requested test (86804).* Lab report with detailed results including the method used (e.g., immunoblot).* Any relevant clinical notes justifying the medical necessity of the test.
** This code should only be reported for confirmatory antibody testing; it is not appropriate for antigen detection. Always refer to the most current CPT codebook and payer guidelines for accurate coding and reimbursement.
- Revenue Code: T1H (LAB TESTS - OTHER)
- RVU: Information not available.RVUs vary based on geographic location and payer.
- Global Days: Not applicable.
- Payment Status: Active
- Modifier TC rule: Not applicable; this is a laboratory test.
- Fee Schedule: Historical fee schedule data is not available in the provided source. Consult payer-specific fee schedules for historical reimbursement information.
- Specialties:Infectious Disease, Gastroenterology, Hepatology
- Place of Service:Laboratory, Hospital (inpatient or outpatient), Physician's office