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The CPT® Code 86701 refers to the laboratory test for the detection of antibodies to HIV-1, which is a virus responsible for causing HIV infections. HIV, or Human Immunodeficiency Virus, is primarily transmitted through sexual contact, but it can also be spread through unscreened blood transfusions, sharing of needles, from an infected mother to her child during pregnancy or childbirth, and through breastfeeding. The virus specifically targets the immune system, particularly attacking T cells, also known as CD4 cells, which are crucial for the body's defense against infections. As the virus progresses, it can lead to Acquired Immunodeficiency Syndrome (AIDS), the most severe phase of HIV infection. The testing process involves obtaining a blood sample from the patient, which is then analyzed to determine the presence or absence of antibodies specific to HIV-1. This test is qualitative, meaning it assesses whether antibodies are present without quantifying their levels. The result indicates whether the individual has been exposed to HIV-1. For reporting purposes, CPT® Code 86701 is specifically used for antibody screening for HIV-1 when performed using a qualitative chemiluminescent immunoassay. It is important to note that there are additional codes for testing HIV-2 and for combined testing of both HIV-1 and HIV-2, which are CPT® Codes 86702 and 86703, respectively.
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The CPT® Code 86701 is indicated for use in the following scenarios:
The procedure for conducting the antibody test for HIV-1 using CPT® Code 86701 involves several key steps:
After the procedure, patients may be advised on the following post-procedure care and considerations:
Patients should be informed about the importance of follow-up testing if the result is positive, as confirmatory testing is required to establish a definitive diagnosis of HIV infection. Additionally, healthcare providers may discuss preventive measures, treatment options, and counseling services available for individuals who test positive for HIV. It is also essential to provide emotional support and resources for patients who may experience anxiety or distress following the test results. Regular monitoring and follow-up appointments may be recommended to ensure ongoing health and management of any potential HIV-related conditions.
| Short Descr | HIV-1ANTIBODY | Medium Descr | ANTIBODY HIV-1 | Long Descr | Antibody; HIV-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) | Yes | 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 | 1 | CCS Clinical Classification | 235 - Other Laboratory |
| 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. | QW | Clia waived test | 92 | Alternative laboratory platform testing: when laboratory testing is being performed using a kit or transportable instrument that wholly or in part consists of a single use, disposable analytical chamber, the service may be identified by adding modifier 92 to the usual laboratory procedure code (hiv testing 86701-86703, and 87389). the test does not require permanent dedicated space, hence by its design may be hand carried or transported to the vicinity of the patient for immediate testing at that site, although location of the testing is not in itself determinative of the use of this modifier. | GA | Waiver of liability statement issued as required by payer policy, individual case | 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 | 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. | 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. | 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. | 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. | 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 | GX | Notice of liability issued, voluntary under payer policy | GZ | Item or service expected to be denied as not reasonable and necessary | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2013-01-01 | Changed | Short Descriptor changed. |
| 1993-01-01 | Added | First appearance in code book in 1993. |
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