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The CPT® Code 86602 refers to the laboratory test for antibodies to actinomyces, a group of bacteria known to cause infections in humans. This test specifically detects the presence of immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies against actinomyces organisms. There are several species of actinomyces, including A. israelii, A. gerencseriae, A. naeslundii, A. odontolyticus, A. viscosus, A. meyeri, and Propionibacterium propionicum, which can lead to subacute or chronic bacterial infections. These infections are characterized by dense granulomatous inflammation and can manifest as painful skin abscesses, lumpy jaw or neck, muscle spasms (lockjaw), fever, weight loss, chest pain, and excessive sinus drainage. The common sites of infection include the oral and cervicofacial regions, thoracic cavity, abdomen, and pelvic area in women. The IgG test is utilized to determine if there has been a past or current infection, while the IgM test is specifically aimed at identifying a current infection. It is important to note that if both IgG and IgM tests are conducted, each immunoglobulin class must be reported separately. Although this antibody test is available, it is not frequently performed, as actinomyces infections are more typically diagnosed through culture and gram stain methods.
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The antibody test for actinomyces (CPT® Code 86602) is indicated for the following conditions:
The procedure for testing antibodies to actinomyces involves several key steps:
After the antibody testing for actinomyces is completed, the patient may not require any specific post-procedure care, as the blood draw is a routine procedure. However, it is essential for healthcare providers to discuss the results with the patient once they are available. If the test indicates the presence of antibodies, further clinical evaluation and management may be necessary based on the patient's symptoms and overall clinical picture. Additionally, if the test results are inconclusive or if there is a high suspicion of actinomyces infection, further diagnostic procedures, such as cultures or imaging studies, may be warranted to confirm the diagnosis and guide treatment.
| Short Descr | ANTINOMYCES ANTIBODY | Medium Descr | ANTIBODY ACTINOMYCES | Long Descr | Antibody; actinomyces | 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 | 3 | 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. | Q4 | Service for ordering/referring physician qualifies as a service exemption |
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| 1993-01-01 | Added | First appearance in code book in 1993. |
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