Summary & Overview
CPT 87651: Streptococcus Group A Detection by Nucleic Acid Amplification
CPT code 87651 represents a laboratory test for the detection of group A Streptococcus using nucleic acid (DNA or RNA) amplified probe technique. This test is a critical tool in diagnosing streptococcal infections, such as pharyngitis and tonsillitis, which are prevalent across the United States. The code is widely recognized and reimbursed by major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, reflecting its importance in clinical practice and coverage policies.
This publication provides a comprehensive overview of 87651, including payer coverage, clinical context, and related coding benchmarks. Readers will gain insight into the laboratory service's role in infectious disease diagnostics, typical sites of service, and how it compares to related CPT codes for Streptococcus testing. The summary also highlights relevant modifiers and associated taxonomies, offering a clear understanding of the code's application in both laboratory and physician settings. Policy updates and coding trends are discussed to inform stakeholders about current practices and reimbursement considerations. The information is designed for a national audience, supporting healthcare professionals, billing specialists, and policy analysts in navigating the complexities of laboratory coding and coverage.
CPT Code Overview
CPT code 87651 is used for the detection of Streptococcus, group A, through nucleic acid (DNA or RNA) amplified probe technique. This laboratory service is typically performed in a clinical laboratory setting, designated as Place of Service 81. The procedure is essential for identifying group A Streptococcus infections, which are commonly associated with conditions such as pharyngitis and tonsillitis. The use of nucleic acid amplification provides a highly sensitive method for detecting the presence of the infectious agent, supporting timely and accurate diagnosis.
Clinical & Coding Specifications
Clinical Context
A patient, typically a child or adolescent, presents to a primary care clinic or urgent care with symptoms such as sore throat, fever, and difficulty swallowing. The provider suspects a streptococcal infection based on clinical assessment. A throat swab is collected and sent to a clinical laboratory (Place of Service 81) for testing. The laboratory performs nucleic acid amplification to detect Streptococcus, group A, using CPT code 87651. The results assist the provider in confirming or ruling out streptococcal pharyngitis or tonsillitis, guiding further management.
Coding Specifications
Common Modifiers:
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Modifier
59: Distinct Procedural Service. Used when the procedure is performed separately from other services, indicating it is not part of a bundled service. -
Modifier
91: Repeat Clinical Diagnostic Laboratory Test. Used when the same laboratory test is repeated on the same patient on the same day to obtain additional information.
Associated Provider Taxonomies:
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