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The CPT® Code 86160 refers to the measurement of complement antigens, specifically indicating that the procedure involves testing for each complement component present in a blood sample. Complement proteins are crucial components of the immune system, playing a significant role in the clearance of immune complexes from the bloodstream. When immune complexes are formed, these proteins are activated, leading to a cascade of reactions that generate peptides. These peptides bind to the immune complexes and complement receptors, facilitating their removal from circulation. The process ultimately results in the formation of an attack complex that can disrupt cell membranes, contributing to the immune response. To perform this test, a blood sample is collected through a venipuncture, which is a separate and reportable procedure. The complement components are analyzed in either serum or plasma samples, utilizing specific methodologies, with quantitative radial immunodiffusion being a commonly employed technique. The code 86160 is reported for each complement component tested, which may include components such as 2-9 (notably, 2 is associated with the most common inherited complement deficiency), 3A (the most abundant complement component), 4A, and 1Q, as well as complement factor B, Bb, and C1-esterase inhibitor.
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The procedure associated with CPT® Code 86160 is indicated for the assessment of complement antigen levels in patients who may be experiencing immune system deficiencies or disorders. The following conditions may warrant this testing:
The procedure for measuring complement antigens involves several key steps that ensure accurate results. First, a qualified healthcare professional performs a venipuncture to obtain a blood sample from the patient. This step is critical as it allows for the collection of serum or plasma, which is necessary for the subsequent analysis. Once the blood sample is collected, it is processed to separate the serum or plasma from the cellular components. The sample is then subjected to specific testing methods, with quantitative radial immunodiffusion being a commonly used technique for measuring complement levels. During this process, the complement components are analyzed individually, and the results are quantified to determine the levels of each antigen present in the sample. The testing may include various complement components such as 2-9, 3A, 4A, 1Q, complement factor B, Bb, and C1-esterase inhibitor. Each component is reported separately under the CPT® Code 86160, allowing for a comprehensive evaluation of the complement system's functionality.
After the completion of the complement antigen testing, the patient may be advised to resume normal activities, as there are typically no significant post-procedure care requirements associated with venipuncture. However, it is essential for healthcare providers to monitor the patient for any potential adverse reactions to the blood draw, such as bruising or discomfort at the puncture site. The results of the complement testing will be analyzed and interpreted by the healthcare provider, who will discuss the findings with the patient and determine any necessary follow-up actions or treatments based on the complement levels measured. This may include further diagnostic testing or referrals to specialists if deficiencies or abnormalities are identified.
| Short Descr | COMPLEMENT ANTIGEN | Medium Descr | COMPLEMENT ANTIGEN EACH COMPONENT | Long Descr | Complement; antigen, each component | Status Code | Statutory Exclusion (from MPFS, may be paid under other methodologies) | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | CLIA Waived (QW) | No | APC Status Indicator | Conditionally packaged laboratory tests | Type of Service (TOS) | 5 - Diagnostic Laboratory | Berenson-Eggers TOS (BETOS) | T1H - Lab tests - other (non-Medicare fee schedule) | MUE | 4 | CCS Clinical Classification | 235 - Other Laboratory |
| 90 | Reference (outside) laboratory: when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number. | 91 | Repeat clinical diagnostic laboratory test: in the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of modifier 91. note: this modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. this modifier may not be used when other code(s) describe a series of test results (eg, glucose tolerance tests, evocative/suppression testing). this modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | GA | Waiver of liability statement issued as required by payer policy, individual case | Q4 | Service for ordering/referring physician qualifies as a service exemption | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | GW | Service not related to the hospice patient's terminal condition | 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GZ | Item or service expected to be denied as not reasonable and necessary | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | PN | Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital | PO | Excepted service provided at an off-campus, outpatient, provider-based department of a hospital | Q3 | Live kidney donor surgery and related services | QJ | Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b) | QW | Clia waived test | RT | Right side (used to identify procedures performed on the right side of the body) | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter |
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| 2011-01-01 | Changed | Short description changed. |
| 1993-01-01 | Added | First appearance in code book in 1993. |
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