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Tick-borne diseases

The clinical presentation does not always tell the whole story

While many tick-borne diseases have overlapping symptoms that include fever, rash, body aches, fatigue, headaches, and chills, some patients are asymptomatic and/or experience a delay in the appearance of symptoms. To complicate the picture, in many cases, coinfection with multiple tick-borne diseases is common. A 2015–2022 analysis of babesiosis cases found a 42% prevalence of 1 or more coinfections.1 With the likelihood of overlapping symptoms and coinfections, identifying a specific tick-borne illness can be challenging, although it’s essential to initiating the right treatment. Selecting and using the right laboratory test can help uncover actionable insights, sooner. 

 

Tick-borne disease: a growing problem across the country

46,115

total reported cases of tick-borne disease in 2019-20222

48

states reporting cases of tick-borne disease3

34,945

cases of Lyme disease2

320%

increase in number of northeastern US counties having a high incidence of Lyme disease4

Make timely, tick-borne disease diagnoses with comprehensive testing from Quest

When it comes to diagnosing tick-borne disease, the timing and selection of the appropriate test is critical. Depending upon the patient’s initial exposure, onset, and presence of symptoms, Quest Diagnostics offers more than 30 tick-borne disease tests and panels to help make an informed diagnosis and initiate the right treatment, which could lead to better outcomes for your patients.
Testing info
Doctor discussing with patient

Make timely, differential tick-borne disease diagnoses with comprehensive testing from Quest

Quest Diagnostics offers a comprehensive menu for tick-borne disease testing that aligns with CDC recommendations.

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Knowing which tests to choose when

  • The CDC recommends 2-step serologic testing for Lyme disease, using a validated standard two-tier test (STTT) or modified two-tier test (MTTT) algorithm5
  • Recommendations for testing other tick-borne diseases is limited, in part due to lower national prevalence; however, the CDC identifies the types of laboratory tests that should be used for confirming cases of tick-borne diseases includes serology and molecular testing, such as PCR6-8
  • Depending on the timing and presence of symptoms, Quest Diagnostics offers individual testing and panels for tick-borne diseases, which can help provide the diagnostic insight you need

A general pattern for molecular vs serologic testing

Timing of testing is critical

In general, molecular testing is indicated during the acute phase of infection prior to antibody development, and this window of time may differ among various tick-borne pathogens. For example, Borrelia burgdorferi (Lyme) DNA may only be present in the blood for up to 48 hours9

Antibodies may begin to develop 4-7 days or later after disease onset and can take up to several weeks to become well established9

Test code: 16220

When: Days/months/years after disease onset

The science: Detection of IgM and IgG antibodies 4-7 days or later after disease onset 

Panel information:

Test code

16220

Preferred  specimen

2 mL serum collected in a serum separator tube (SST) and transferred to a plastic transport tube

Turnaround time

1-3 days

Panel componentsaLyme Disease Antibody with Reflex to Immunoassay (IgG, IgM) (39733), Anaplasma phagocytophilum Antibodies (IgG, IgM) with Reflex to Titersb (16189), Babesia microti Antibodies (IgG, IgM) with Reflex to Titersb (16194), Ehrlichia chaffeensis (IgG, IgM) with Reflex to Titersb (16197)

a Components of panels can be ordered separately.

b This test was developed, and its analytical performance characteristics have been determined by Quest Diagnostics. It has not been cleared or approved by FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.

Test codes: Tick-borne Disease, Acute Molecular Panel: 94322
Tick-borne Disease, Acute Molecular Panel, Non-Lyme: 32338

When: Within the first 14 days of infection

The science: Detection of different pathogens that may be in the blood for shorter periods of time, some only 24-48 hours

Panel information:

Test code

94322 and 32338

Preferred specimen 

3 mL whole blood collected in an EDTA (lavender-top) tube

Turnaround time 

2-3 days

Panel componentsaIndividual tests/panel components for Tick-borne Diseases, Acute Molecular Panel, Non-Lyme include Anaplasma Phagocytophilum DNA, Qualitative Real-Time PCR b (17320), Babesia microti DNA, Real-Time PCR b (37314), Borrelia miyamotoi DNA, Real-Time PCR, Miscellaneous b (93795), Ehrlichia chaffeensis DNA, Real-Time PCR b (11353).
Tick-borne Disease, Acute Molecular Panel includes the components of Tick-borne Diseases, Acute Molecular Panel, Non-Lyme plus Borrelia Species DNA, Qualitative Real-Time PCR b,c (15777).

a Components of panels can be ordered separately.

b This test was developed, and its analytical performance characteristics have been determined by Quest Diagnostics. It has not been cleared or approved by FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.

c Not included in Tick-borne Disease, Acute Molecular Panel, Non-Lyme.

References:

1. Ssentongo P, Venugopal N, Zhang Y, et al. Beyond human babesiosis: prevalence and association of Babesia coinfection with mortality in the United States, 2015–2022: a retrospective cohort study. Open Forum Infect Dis. 2024 Oct 8;10(11):ofae504. https://doi.org/10.1093/ofid/ofae504

2. CDC. Tickborne disease surveillance data summary. Reviewed July 24, 2024. Accessed April 17, 2026. https://www.cdc.gov/ticks/data-research/facts-stats/tickborne-disease-surveillance-data-summary.html?CDC_AAref_Val=https://www.cdc.gov/ticks/data-summary/index.htm

3. CDC. Overview of tickborne diseases. Reviewed August 5, 2022. Accessed February 24, 2023. https://www.cdc.gov/ticks/tickbornediseases/overview.html

4. Kugeler KJ, Farley GM, Forrester JD, et al. Geographic distribution and expansion of human Lyme disease, United States. Emerg Infect Dis. 2015;21(8):1455-1457. doi:10.3201/eid2108.141878

5. CDC. Tickborne Diseases of the United States. Accessed April 17, 2026. https://www.cdc.gov/ticks/hcp/data-research/tickborne-disease-reference-guide/index.html

6. CDC. National Notifiable Diseases Surveillance System (NNDSS). Ehrlichiosis and anaplasmosis 2008 case definition. Reviewed April 16, 2021. Accessed April 17, 2026. https://ndc.services.cdc.gov/case-definitions/ehrlichiosis-and-anaplasmosis-2008/

7. CDC. National Notifiable Diseases Surveillance System (NNDSS). Lyme disease (Borrelia burgdorferi) 2022 case definition. Reviewed August 30, 2021. Accessed April 17, 2026. https://ndc.services.cdc.gov/case-definitions/lyme-disease-2022/

8. CDC. National Notifiable Diseases Surveillance System (NNDSS). Babesiosis (Babesia spp.) 2011 case definition. Reviewed April 16, 2021. Accessed April 10, 2023. https://ndc.services.cdc.gov/case-definitions/babesiosis-2011/

9. CDC. Emerging tickborne diseases: CDC public health grand rounds emerging tickborne diseases. Encore presentation on Tuesday, July 16, 2019. Accessed April 17, 2026. https://www.cdc.gov/grand-rounds/pp/2017/20170321-tickborne-diseases.html

 

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.

 

Test codes may vary by location. Please contact your local laboratory for more information.

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