CPT® Code 86617 is used to report confirmatory antibody testing for Borrelia burgdorferi, the bacterium that causes Lyme disease. This test is typically performed after an initial screening test (such as an enzyme immunoassay or EIA) returns positive or equivocal results. Confirmatory testing helps verify the presence of specific antibodies to Borrelia burgdorferi, supporting accurate diagnosis and appropriate treatment planning.
This test is commonly performed using immunoblot (Western blot) or similar confirmatory serologic methods.
Key Facts About CPT® 86617
Service type: Laboratory serologic confirmatory test
Provider type: Physicians and qualified healthcare professionals who order laboratory testing
Medical services included: Yes—confirmatory detection of antibodies to Borrelia burgdorferi
Specimen type: Serum
Test method: Immunoblot (Western blot) or equivalent confirmatory serologic method
Common clinical indications:
- Confirmation of positive or equivocal Lyme disease screening test results
- Evaluation of patients with suspected Lyme disease
- Assessment of symptoms such as rash, joint pain, fatigue, or neurologic symptoms
- Follow-up testing after potential tick exposure
- Diagnostic evaluation of unexplained inflammatory or neurologic conditions
When to Use CPT® 86617
CPT 86617 is appropriate when:
- A confirmatory antibody test for Borrelia burgdorferi is performed following a positive or equivocal screening test
- The test is medically necessary to confirm Lyme disease diagnosis
- Results are used to guide treatment decisions and clinical management
- The test is performed on a properly collected and processed serum specimen
Examples:
- Confirming Lyme disease after a positive enzyme immunoassay (EIA) screening test
- Evaluating a patient with suspected Lyme disease and compatible symptoms
- Confirmatory testing following tick exposure and positive screening results
- Supporting diagnosis in patients with suspected Lyme-related neurologic or joint symptoms
Documentation Requirements
To support CPT 86617 billing, documentation should include:
- Patient identifiers and date of service
- Provider order for Borrelia burgdorferi confirmatory antibody testing
- Clinical indication and relevant patient history
- Reference to prior positive or equivocal screening test, if applicable
- Specimen type and collection date
- Test results and interpretation
- Ordering provider credentials and signature
- Laboratory performing the test
Complete documentation supports accurate diagnosis, compliance, and reimbursement.
Reimbursement and Coding Considerations
- CPT 86617 is typically billed following a positive or equivocal Lyme disease screening test
- Coverage depends on medical necessity and payer-specific diagnostic guidelines
- Confirmatory testing is essential to support definitive diagnosis and treatment planning
- Proper diagnosis coding should reflect suspected or confirmed Lyme disease or relevant symptoms
- Verify payer-specific requirements for Lyme disease testing and reimbursement
Accurate coding and documentation help ensure proper reimbursement and reduce claim denials.
How OptiMantra Supports Lyme Disease Confirmatory Testing
OptiMantra’s integrated EMR and practice management system streamlines ordering, documentation, and billing for CPT 86617:
With OptiMantra, providers can:
- Order confirmatory Lyme disease antibody tests directly from the patient chart
- Document clinical indications, symptoms, and prior screening test results
- Capture and store laboratory results within the patient’s longitudinal health record
- Link confirmatory test results to diagnoses, treatment plans, and follow-up care
- Support accurate CPT and ICD-10 code selection for compliant laboratory billing
By centralizing laboratory testing workflows, OptiMantra helps practices improve efficiency, ensure compliance, and optimize reimbursement.
Try OptiMantra for free here!
Disclaimer: CPT® codes are maintained by the American Medical Association. This guide is for informational purposes only and does not replace official coding guidelines or payer policies.
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