Need help choosing the right code?
Ask CasePilot about procedures, modifiers, bundling, and coding guidance.
Try CasePilot© Copyright 2026 American Medical Association. All rights reserved.
The CPT® Code 86695 refers to the laboratory testing for antibodies specific to herpes simplex virus type 1 (HSV-1). This procedure involves analyzing a blood or cerebrospinal fluid sample to detect the presence of antibodies that indicate an immune response to HSV-1 infection. Herpes simplex virus is primarily transmitted through direct contact with an infected individual, and the initial infection often manifests as ulcerative lesions on the skin or mucous membranes. After the primary infection, the virus can enter a dormant or latent state within the body, remaining inactive until it is reactivated by various triggers such as other illnesses, infections, or stress. Certain populations, including neonates and individuals with compromised immune systems, are particularly vulnerable to severe complications from HSV-1, which can include infections of the eyes or central nervous system. To diagnose HSV infection, various testing methodologies are employed, including indirect hemagglutination (IHA), chemiluminescent immunoassay, and enzyme-linked immunosorbent assay (ELISA). The testing typically involves measuring two types of immunoglobulins: IgG and IgM. It is important to note that if both IgG and IgM tests are conducted, each test should be reported separately. For non-specific HSV testing, the code 86694 is utilized, while code 86695 is designated for tests specifically identifying HSV type 1. Conversely, code 86696 is used for tests that are specific to HSV type 2. Additionally, these codes can also be applied to report the presence of glycoprotein G-specific antibodies for both HSV type 1 and type 2, encompassing both IgG and IgM classes.
© Copyright 2026 Coding Ahead. All rights reserved.
The testing for antibodies to herpes simplex virus type 1 (HSV-1) is indicated in the following scenarios:
The procedure for testing antibodies to herpes simplex virus type 1 involves several key steps:
After the antibody testing for herpes simplex virus type 1, the patient may not require any specific post-procedure care, as the test is non-invasive. However, it is essential for healthcare providers to discuss the results with the patient, especially if the test indicates a recent or active infection. In cases of positive results, further clinical evaluation and management may be necessary, particularly for high-risk individuals. Patients should be informed about the implications of their test results and any recommended follow-up actions, including potential antiviral treatments or preventive measures to reduce the risk of transmission.
| Short Descr | HERPES SIMPLEX TYPE 1 TEST | Medium Descr | ANTIBODY HERPES SMPLX TYPE 1 | Long Descr | Antibody; herpes simplex, type 1 | 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 | 2 | 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. | 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. | 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. | 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. | 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 | 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. | GA | Waiver of liability statement issued as required by payer policy, individual case | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | KX | Requirements specified in the medical policy have been met | SA | Nurse practitioner rendering service in collaboration with a physician | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2013-01-01 | Changed | Short Descriptor changed. |
| 2002-01-01 | Changed | Code description changed. |
| 1993-01-01 | Added | First appearance in code book in 1993. |
Get instant expert-level medical coding assistance.