Summary & Overview
CPT 87635: Laboratory Detection of SARS-CoV-2 via Nucleic Acid Amplification
CPT code 87635 represents the laboratory detection of SARS‑CoV‑2, the virus responsible for COVID-19, using nucleic acid amplification methods. This code is a cornerstone of national COVID-19 testing strategies, enabling rapid identification of infection and supporting public health efforts. The procedure is typically performed in laboratory or office settings and is widely recognized by major payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.
This publication provides a comprehensive overview of 87635, including payer coverage, clinical context, and policy updates relevant to laboratory infectious agent detection. Readers will gain insight into coding benchmarks, reimbursement trends, and the role of this code in COVID-19 screening and diagnosis. The analysis also highlights associated modifiers, provider taxonomies, and related codes, offering a clear understanding of how 87635 fits within broader laboratory billing practices. As COVID-19 continues to impact healthcare delivery, understanding the nuances of this code is essential for stakeholders across the industry.
CPT Code Overview
CPT code 87635 is used for the detection of severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), the virus responsible for COVID-19, through nucleic acid amplification techniques. This laboratory service identifies the presence of viral DNA or RNA, providing critical information for diagnosing COVID-19. The typical site of service for this procedure is a laboratory (POS 81) or an office setting (POS 11). This code is central to COVID-19 testing protocols and supports timely clinical decision-making during the ongoing public health response.
Clinical & Coding Specifications
Clinical Context
A patient presents to a healthcare provider's office or a laboratory with symptoms suggestive of COVID-19, such as fever, cough, or shortness of breath, or has had known exposure to someone with COVID-19. The provider orders a laboratory test to detect the presence of SARS-CoV-2 using an amplified probe technique. The specimen, typically a nasopharyngeal swab, is collected and sent to a laboratory (Place of Service 81) or performed in the office (Place of Service 11). The laboratory uses nucleic acid amplification to detect viral RNA, and the results inform clinical management, isolation protocols, and public health reporting.
Coding Specifications
- Modifier
QW: Indicates that the test performed is CLIA-waived, meaning it is approved for use in settings with a Certificate of Waiver under the Clinical Laboratory Improvement Amendments. This modifier is used when the laboratory or office is performing a test that meets CLIA waiver criteria.
| Modifier Code | Description |
|---|---|
QW | CLIA-waived test performed |
- Provider Taxonomies: