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The CPT® Code 86703 refers to the laboratory test for the detection of antibodies to both HIV-1 and HIV-2 in a single result. HIV, or Human Immunodeficiency Virus, is a virus that can lead to Acquired Immunodeficiency Syndrome (AIDS), a condition characterized by a severely weakened immune system. The virus is primarily transmitted through sexual contact, but it can also be spread through unscreened blood transfusions, sharing of needles, from mother to child during pregnancy or childbirth, and through breastfeeding. The immune system is compromised as HIV targets and destroys CD4 T cells, which are crucial for the body's ability to combat infections. The test associated with CPT® Code 86703 is a qualitative assessment, meaning it determines the presence or absence of antibodies specific to HIV-1 and/or HIV-2 in a blood sample. This test is essential for diagnosing HIV infections, allowing for timely intervention and management. It is important to note that this code is specifically used when both HIV-1 and HIV-2 antibodies are tested simultaneously, providing a comprehensive result in a single testing process. For more specific testing, separate codes are available: CPT® Code 86701 is used for HIV-1 antibody screening via a qualitative chemiluminescent immunoassay, while CPT® Code 86702 is designated for HIV-2 antibody screening using a qualitative enzyme immunoassay.
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The CPT® Code 86703 is indicated for the detection of antibodies to HIV-1 and HIV-2 in individuals who may be at risk for HIV infection. The following conditions or situations warrant the use of this test:
The procedure for testing antibodies to HIV-1 and HIV-2 using CPT® Code 86703 involves several key steps:
After the antibody testing for HIV-1 and HIV-2 is completed, the following post-procedure considerations are important:
Patients should be informed about the significance of their test results. If the test is positive, further confirmatory testing is typically required to establish a definitive diagnosis. Healthcare providers may also discuss the implications of a positive result, including treatment options and the importance of notifying sexual partners. In the case of a negative result, patients may still be advised on preventive measures, especially if they are at ongoing risk for HIV infection. Additionally, routine follow-up testing may be recommended based on individual risk factors and healthcare provider guidelines.
| Short Descr | HIV-1/HIV-2 1 RESULT ANTBDY | Medium Descr | ANTIBODY HIV-1&HIV-2 SINGLE RESULT | Long Descr | Antibody; HIV-1 and HIV-2, single result | 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 | 1 | 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. | GA | Waiver of liability statement issued as required by payer policy, individual case | 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. | 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. | GZ | Item or service expected to be denied as not reasonable and necessary | 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 | 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. | 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. | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q4 | Service for ordering/referring physician qualifies as a service exemption | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | QW | Clia waived test | U6 | Medicaid level of care 6, as defined by each state | 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. |
| 2012-01-01 | Changed | Description Changed |
| 2011-01-01 | Changed | Short description changed. |
| 1993-01-01 | Added | First appearance in code book in 1993. |
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