CPT 87481: Laboratory Test for Candida Species, Amplified Probe Technique

CPT code 87481 represents a laboratory test for the detection of Candida species using an amplified nucleic acid probe technique. This code is significant in clinical practice for its role in diagnosing fungal infections, which are increasingly relevant in both outpatient and inpatient settings. The procedure is commonly performed in independent laboratories, ensuring precise identification of Candida, a key pathogen in genitourinary and other systemic infections.

Major national payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. The publication provides a comprehensive overview of payer coverage, clinical context, and policy benchmarks related to CPT code 87481. Readers will gain insights into coding practices, typical sites of service, and the importance of accurate laboratory testing for infectious agents. The summary also highlights relevant modifiers and associated taxonomies, offering a clear understanding of how this code fits into broader laboratory and pathology billing workflows.

This article is designed for healthcare professionals, billing specialists, and policy analysts seeking up-to-date information on laboratory testing for Candida species. It covers essential details for compliance, reimbursement, and clinical application, supporting informed decision-making in medical billing and laboratory operations.

CPT Code Overview

CPT code 87481 is used to report laboratory testing for Candida species utilizing an amplified nucleic acid probe technique. This procedure falls under the category of Pathology and Laboratory Procedures – Infectious Agent Antigen Detection, providing a sensitive method for identifying Candida infections. The typical site of service for this test is an Independent Laboratory (Place of Service 81), where specialized equipment and expertise are available for accurate detection of infectious agents.

Clinical Context

A patient presents to a family medicine or obstetrics & gynecology clinic with symptoms suggestive of a genitourinary infection, such as abnormal discharge, irritation, or discomfort. The provider suspects a possible Candida infection and orders a laboratory test to detect Candida species using an amplified nucleic acid probe technique. The specimen is collected and sent to an independent clinical medical laboratory (Place of Service 81) for analysis. The laboratory performs the test corresponding to CPT code 87481 and reports the results back to the provider for further clinical management.

Coding Specifications

Modifiers:

Modifier Code Description When Used
59 Distinct Procedural Service Used when multiple procedures are performed and need to be identified as separate and distinct from each other.
91

Modifier Code	Description	When Used
`59`	Distinct Procedural Service	Used when multiple procedures are performed and need to be identified as separate and distinct from each other.
`91`

National mean rates for CPT 87481 show that BUCA (average commercial) payers reimburse at $33.02, while Medicare rates are not available in the input. Among individual commercial payers, Cigna has the highest mean rate at $39.05, and UnitedHealth Group has the lowest at $29.95.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Cigna exhibits the widest spread ($48.00 - $20.00 = $28.00), indicating significant variability in reimbursement. UnitedHealth Group has the tightest range ($33.00 - $16.00 = $17.00), suggesting more consistent rates. Aetna, Blue Cross Blue Shield, and BUCA fall in between, with ranges of $16.00, $15.50, and $16.78, respectively.

The table and chart below present the full breakdown of national benchmarks for each payer, including mean rates and percentile values.

Taxonomy Code	Specialty
`291U00000X`	Clinical Medical Laboratory
`207Q00000X`	Family Medicine Physician
`207V00000X`	Obstetrics & Gynecology Physician

Related Diagnoses

A56.00 - Chlamydial infection of lower genitourinary tract, unspecified
- Relevant when screening for or differentiating between Candida and chlamydial infections in patients with genitourinary symptoms.
A56.01 - Chlamydial cystitis and urethritis
- Used when evaluating patients with cystitis or urethritis, where Candida infection may be considered in the differential diagnosis.
A56.09 - Other chlamydial genitourinary infections
- Applies to cases where other chlamydial infections are suspected alongside possible Candida infection.
Z11.3 - Encounter for screening for infections with a predominantly sexual mode of transmission
- Used for patients undergoing screening for sexually transmitted infections, including Candida species.
Z20.2 - Contact with and (suspected) exposure to infections with a predominantly sexual mode of transmission
- Relevant for patients who have been exposed to sexually transmitted infections and require testing for Candida species.

Related CPT Codes

87482: Data not available in the input.

Relation to CPT code 87481:

87482 is listed as a related CPT code but no description is provided. Typically, related codes may represent similar or complementary laboratory tests that could be ordered in conjunction with or as alternatives to 87481 in the clinical workflow. Without further description, specific clinical relationships cannot be detailed.

The table and chart below present the full breakdown of national benchmarks for each payer, including mean rates and percentile values.

OpenPayer

Summary & Overview