2025 CPT code 86813
(Active) Effective Date: N/A Revision Date: N/A Pathology and Laboratory Procedures - Tissue Typing Immunological Procedures Immunology Procedures Feed
Serologic test identifying multiple HLA Class I antigens (A, B, and C).
Modifiers may apply depending on the specific circumstances, such as the location of service or the use of an outside laboratory.Consult the current CPT guidelines and payer-specific rules for appropriate modifier usage.
Medical necessity for 86813 is established when the results are needed to guide clinical decisions. This is most commonly seen in organ and bone marrow transplant evaluations where HLA matching is critical to transplant success, and in the workup of certain autoimmune diseases.
The clinical responsibility lies primarily with the laboratory analyst who performs the technical aspects of the HLA typing. The ordering physician is responsible for medical necessity and appropriate interpretation of results in the context of patient care.
In simple words: This lab test checks for specific markers (HLA) on white blood cells to see if a donor's tissue or organ is a good match for a recipient before a transplant.It helps reduce the chance of the recipient's body rejecting the transplant.
This CPT code encompasses the serological testing to identify multiple human leukocyte antigens (HLA) from one or more of the three major HLA Class I cell surface antigens (A, B, and C).The procedure involves isolating lymphocytes from a patient's blood sample, placing them in test wells containing sera with antibodies to known HLA types, and incubating with a vital dye.Cell death, indicated by dye activation, signifies the presence of complement HLA, observable via phase-contrast microscopy.A single unit of 86813 covers testing for any number of HLA antigens within groups A, B, or C. This test is often used to assess donor-recipient compatibility for transplants (organ or bone marrow).
Example 1: A patient is scheduled for a kidney transplant.86813 is used to determine the HLA compatibility between the donor and recipient to minimize the risk of rejection., A patient requires a bone marrow transplant.Prior to the procedure, 86813 is performed to determine the HLA compatibility between the donor and recipient., A patient presents with a suspected autoimmune disorder.HLA typing using 86813 may help in the diagnosis, as specific HLA alleles are associated with increased risk for certain autoimmune diseases.
* Patient's complete medical history, including any prior transplants or autoimmune disorders.* Reason for ordering the test (e.g., transplant evaluation, autoimmune disease investigation).* Detailed laboratory report including the specific HLA antigens identified.* Appropriate documentation of specimen collection.
** This code is specifically for serological methods of HLA typing.Different codes are used for molecular methods.
- Revenue Code: T1H (LAB TESTS - OTHER (NON-MEDICARE FEE SCHEDULE))
- RVU: The relative value units (RVUs) for this code will vary depending on the specific payer and location. Consult your local fee schedule or payer's website for the most current information.
- Global Days: This is a laboratory test, so there is no global surgical period.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier is not applicable to this code, as it represents a complete laboratory procedure.
- Fee Schedule: Historical fee schedule data is not available in the provided information.Consult a historical fee schedule database or your payer for specific historical fee data.
- Specialties:Transplantation, Immunology, Hematology, Pathology
- Place of Service:Laboratory