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The CPT® Code 86765 refers to the laboratory test performed to measure antibodies specific to rubeola, commonly known as measles. This test is crucial for diagnosing current or recent infections as well as for determining immunity status following vaccination. Rubeola is a highly contagious viral infection that spreads through respiratory droplets, leading to symptoms such as fever, runny nose, cough, and a characteristic body rash. The infection can result in serious complications, particularly in vulnerable populations such as infants and children under 5 years of age, as well as adults over 20, who are at a higher risk for severe disease and associated complications like otitis media and pneumonia. The test measures two types of antibodies: IgM and IgG. A positive IgM antibody titer indicates either a current or recent infection or immunization, although it is important to note that low levels of IgM can persist for over 12 months after the initial infection or vaccination. Conversely, a positive IgG antibody titer suggests that the individual has either been exposed to the virus in the past or has been vaccinated. The testing process involves obtaining a blood sample through venipuncture, which is reported separately, and cerebrospinal fluid (CSF) through a lumbar puncture, also reported separately. The laboratory utilizes semi-quantitative enzyme-linked immunosorbent assay (ELISA) for detecting IgM antibodies and semi-quantitative chemiluminescent immunoassay for IgG antibodies, ensuring accurate measurement of the immune response to the rubeola virus.
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The rubeola antibody test (CPT® Code 86765) is indicated for the following conditions:
The procedure for conducting the rubeola antibody test involves several key steps:
After the rubeola antibody test is performed, patients may experience minimal discomfort at the venipuncture or lumbar puncture site, which typically resolves quickly. It is important for healthcare providers to monitor patients for any adverse reactions, particularly after a lumbar puncture, which may include headache or back discomfort. The results of the antibody tests will guide further clinical decisions, including the need for additional testing, treatment options, or vaccination recommendations. Patients should be informed about when to expect their results and any follow-up actions that may be necessary based on the findings.
| Short Descr | RUBEOLA ANTIBODY | Medium Descr | ANTIBODY RUBEOLA | Long Descr | Antibody; rubeola | 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. | Q4 | Service for ordering/referring physician qualifies as a service exemption | 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. | 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. | 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. | 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. | GA | Waiver of liability statement issued as required by payer policy, individual case | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | 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 |
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| 1993-01-01 | Added | First appearance in code book in 1993. |
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