Summary & Overview
CPT 87207: Smear with Special Stain for Intracellular Parasites
CPT code 87207 represents a specialized laboratory test that involves preparing and interpreting a smear from a primary specimen using special stains to identify inclusion bodies or intracellular parasites, including organisms such as malaria, kala azar, and herpes. This procedure is critical in the diagnosis of infectious diseases, enabling clinicians to detect pathogens that may not be visible with standard staining techniques. The code is widely recognized and utilized across the United States, reflecting its importance in clinical laboratory medicine.
Major national payers covering this service include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The publication provides an overview of payer coverage, clinical context, and relevant policy updates for this laboratory service. Readers will gain insights into typical sites of service, associated clinical specialties, and common diagnoses linked to the use of CPT code 87207. The article also highlights related CPT codes and modifiers, offering a comprehensive view of how this procedure fits within broader laboratory and pathology billing practices. Benchmarks and regulatory considerations are discussed to inform stakeholders about current trends and requirements for laboratory testing involving special stains for intracellular pathogens.
CPT Code Overview
CPT code 87207 is used to report a laboratory procedure involving a smear from a primary source, with interpretation, utilizing a special stain to detect inclusion bodies or intracellular parasites such as malaria, kala azar, or herpes. This service is classified as a laboratory procedure and is typically performed in a laboratory setting (Place of Service 81). The code is essential for identifying infectious agents within cells, supporting accurate diagnosis and treatment decisions.
Clinical & Coding Specifications
Clinical Context
A patient presents to a clinic or hospital with symptoms suggestive of an infectious disease, such as fever, sore throat, cough, or diarrhea. The clinician suspects an intracellular infection (e.g., malaria, herpes, or other inclusion body-forming pathogens) and collects a specimen (such as blood, throat swab, or tissue sample). The specimen is sent to the laboratory (Place of Service 81) for analysis. Laboratory personnel perform a special stain on the smear to detect inclusion bodies or intracellular parasites, interpret the results, and report findings to the ordering provider. This workflow supports diagnosis and management of infections where intracellular pathogens are suspected.
Coding Specifications
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Modifiers:
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26: Used when reporting only the professional component (interpretation of the smear and stain) by a pathologist or qualified physician. - Modifier
TC: Used when reporting only the technical component (performance of the staining procedure and preparation of the smear) by the laboratory.
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Associated Provider Taxonomies:
Taxonomy Code Specialty Name