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 87806 refers to a specific diagnostic procedure used for the detection of infectious agents, specifically the human immunodeficiency virus (HIV). This procedure employs an immunoassay method that allows for the direct optical observation of HIV-1 antigens and the presence of antibodies for both HIV-1 and HIV-2. HIV is a retrovirus that significantly impacts the immune system by targeting and destroying CD4+ positive T-cells, which are crucial for immune function. The transmission of HIV occurs through various means, including sexual contact, exposure to infected blood or blood products, and from an infected mother to her child during the perinatal period. HIV-1 is recognized as the primary cause of acquired immune deficiency syndrome (AIDS) globally, while HIV-2 is more commonly found in West Africa. The detection of HIV antigens can occur in serum, plasma, and whole blood approximately 12 to 26 days following infection, while antibodies to the virus typically appear between 20 to 45 days post-infection. The procedure utilizing CPT® Code 87806 is particularly valuable in point-of-care settings, such as clinics and physician offices, where rapid screening is essential. The test is designed for at-risk, asymptomatic individuals, facilitating early detection and timely intervention. The testing process involves the use of a commercial test strip, such as the Alere Determine, where a sample is applied directly. In the case of serum or plasma samples, no additional steps are required, whereas whole blood samples necessitate the addition of a buffering solution. The test strip features both a control zone and a patient section, with results indicated by the presence of red lines that signify either a positive or negative result for the patient.
© Copyright 2026 Coding Ahead. All rights reserved.
The procedure associated with CPT® Code 87806 is indicated for the detection of human immunodeficiency virus (HIV) in individuals who are at risk for infection. The following conditions and circumstances warrant the use of this immunoassay:
The procedure for CPT® Code 87806 involves several key steps to ensure accurate detection of HIV-1 antigens and antibodies. The following outlines the procedural steps:
Following the completion of the procedure associated with CPT® Code 87806, it is essential to interpret the results accurately. A positive result indicates the presence of HIV-1 antigens and/or antibodies, necessitating further confirmatory testing and appropriate clinical follow-up. A negative result suggests that HIV is not detected; however, it is important to consider the window period of the test, as antibodies may not be present immediately after infection. Patients should be counseled on the importance of follow-up testing, especially if they have ongoing risk factors or potential exposure to HIV. Additionally, healthcare providers should ensure that patients receive appropriate education regarding HIV transmission, prevention strategies, and available treatment options if necessary.
| Short Descr | HIV AG W/HIV1&2 ANTB W/OPTIC | Medium Descr | IAADIADOO HIV1 ANTIGEN W/HIV1 & HIV2 ANTIBODIES | Long Descr | Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies | 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 |
| 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 | QW | Clia waived test | QJ | Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b) | GW | Service not related to the hospice patient's terminal condition | 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. | 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. | 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. | FP | Service provided as part of family planning program | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | GZ | Item or service expected to be denied as not reasonable and necessary |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2022-01-01 | Changed | First appearance of change in codebook. |
| 2021-01-01 | Changed | First appearance of change in CPT® Code Set. |
| 2020-10-06 | Changed | Code description changed. |
| 2015-01-01 | Added | Added |
Get instant expert-level medical coding assistance.