Faster, easier diagnoses for tick-borne diseases

As ticks expand their habitat across the US and people travel to and from endemic areas, the incidence of tick-borne diseases continues to increase. Lyme disease and other tick-borne illnesses can vary in severity and symptoms among different patients and different geographic regions. That’s why, when it comes to diagnosing and managing tick-borne illness, knowing when to test and what to test for is essential.

A comprehensive menu for tick-borne disease testing

With the acquisition of the US laboratory services of Imugen, Quest has created a more powerful and comprehensive testing portfolio for tick-borne diseases. Healthcare providers now have access to our:

Full suite of molecular and serological testing, all under 1 roof and with 1 convenient set of test orders   Expanded test menu, providing a more broad and in-depth testing portfolio for tick-borne illnesses
A more comprehensive and differentiating test for Borrelia diagnosis with the addition of the Imugen Borrelia PCR test to the Quest portfolio      

Diagnosing Lyme disease

According to the Centers for Disease Control and Prevention (CDC), approximately 300,000 people may get Lyme disease each year in the US.1 In 2020, the Infectious Diseases Society of America, the American Academy of Neurology, and the American College of Rheumatology issued updated guidelines for the diagnosis and treatment of Lyme disease.2

These guidelines support both two-tier processes recommended by the CDC.3 Quest offers all recommended tests needed for each step.

Standard two-tier test (STTT)

This test includes an enzyme immunoassay or immunofluorescence assay that detects antibodies against the B burgdorferi bacterium, followed by an immunoblot (IgG, IgM) for specimens with positive or equivocal results.3

Step 1: Enzyme immunoassay (EIA) or immunofluorescence assay (IFA)—if negative, no further testing is recommended; if positive or indeterminate, the second step should be performed

Step 2: Immunoblot test—results are considered positive only if the EIA/IFA and immunoblot are both positive

Test NameTest CodeCPT Codes
Lyme Disease Ab with Reflex to Blot (IgG, IgM)664686618

A modified two-tier test (MTTT)

This test is part of an updated recommendation from the CDC for earlier detection and diagnosis of Lyme disease. MTTT utilizes immunoassays rather than immunoblots in the second tier of the algorithm and may be able to assist in the identification of early Lyme disease within the first 30 days of infection.

Step 1: Test serum in an immunoassay measuring combined IgG and IgM antibodies to specific borrelial proteins

Step 2: Verify the results using a second FDA-cleared IgG and IgM immunoassays in place of a Western blot (immunoblot)

Test NameTest CodeCPT Codes
Lyme Disease Antibody with Reflex to Immunoassay (IgG, IgM)3973386618

When to choose STTT vs MTTT Lyme serology algorithm

During early stage Lyme disease (first 30 days of infection), the MTTT has been shown to have improved sensitivity and detect more cases of Lyme as compared to STTT. Either MTTT or STTT are appropriate after early-stage Lyme disease for diagnosis.4


Understanding which tick-borne disease tests to choose, and when

Depending on the timing and presence of symptoms, Quest offers 2 tick-borne disease testing panels that can help provide the insight you need for diagnosis.

Tick-borne Disease, Acute Molecular Panel

When symptoms are present, there are clear signs of Lyme disease, or there is evidence of a tick bite, molecular, polymerase chain reaction (PCR)-based assays may be an appropriate choice. Used 1–2 weeks after disease onset, this test panel is useful for differentiating among some of the more common tick-borne diseases, particularly in acute cases.

Test NameTest CodeCPT Codes
Tick-borne Disease, Acute Molecular Panel9432287798 (x4),

Tick-borne Disease, Antibody Panel

When symptoms are unclear and it is uncertain if or when a tick bite may have occurred, Quest’s serology panel is the ideal choice. This testing panel helps with diagnosis weeks, months, or even years after the onset of a tick-borne disease.

Test NameTest CodeCPT Codes
Tick-borne Disease, Antibody Panel3694286666 (x2), 86753 (x3), 86618, 86666 (x2)
If Lyme Disease Antibody Screen is 0.90, then Lyme Disease Antibodies (IgG, IgM), Immunoblot will be performed at an additional charge (CPT code(s): 86617(x2))

Supporting a coordinated approach

To address Americans’ increased risk of tick-borne diseases, the CDC, five federal departments, and the Environmental Protection Agency developed a joint National Public Health Framework for the Prevention and Control of Vector-Borne Diseases in Humans. Quest fully supports this initiative, offering the comprehensive testing needed for timely, differential diagnoses. Learn more about the joint effort.

The CPT® codes provided are based on American Medical Association guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed.

Make timely, differential tick-borne disease diagnoses.

Learn more about our comprehensive tick-borne disease testing.

Access all tests in the test directory
Download the tick-borne diseases brochure



  1. Centers for Disease Control and Prevention. Tickborne diseases of the United States: a reference manual for health care providers. 4th edition, 2017. Accessed December 23, 2020.
  2. Lantos PM, Rumbaugh J, Bockenstedt LK, et al. Clinical practice guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 guidelines for the prevention, diagnosis and treatment of Lyme disease. Clin Infect Dis. 2020:1-48.
  3. Mead P, Petersen J, Hinckley A. Updated CDC recommendation for serologic diagnosis of Lyme disease. MMWR. 2019;68(32):703.
  4. Zeus Scientific. Clinical data: background. Accessed April 29, 2021.