Summary & Overview
CPT 81514: Molecular Diagnostic Test for Bacterial Vaginosis
CPT code 81514 represents a molecular diagnostic laboratory test that uses quantitative real‑time DNA amplification of vaginal fluid to assess six bacterial species and applies an algorithm to indicate a high likelihood of bacterial vaginosis (BV). This test can also report detection of organisms such as Trichomonas vaginalis and Candida species. Nationally, availability of algorithmic molecular BV testing affects diagnostic pathways for vaginitis and has implications for laboratory workflows, clinical decision support, and payer coverage policies.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for BV testing, common sites of service for the assay, and typical billing considerations tied to CPT code 81514. The publication outlines where benchmarks and policy updates influence coverage decisions and highlights operational factors laboratories should consider when implementing algorithm-based molecular diagnostics. The content provides concise guidance on what the code represents, how it integrates into clinical care for suspected BV, and the types of payer policy and reimbursement topics stakeholders commonly assess when evaluating use of CPT code 81514.
Billing Code Overview
CPT code 81514 describes a laboratory service that performs quantitative real‑time amplification of DNA markers on a vaginal fluid specimen to evaluate six bacterial species and uses an algorithmic analysis combining patient data and test results to report a positive or negative result for a high likelihood of bacterial vaginosis (BV). The report may additionally note detection of other organisms such as Trichomonas vaginalis and Candida species.
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Service type: Molecular diagnostic laboratory test with algorithmic/interpretive reporting
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Typical site of service: Clinical diagnostic laboratory or reference laboratory performing molecular testing
Clinical & Coding Specifications
Clinical Context
A 28-year-old sexually active woman presents to an outpatient gynecology clinic with a 3-day history of increased vaginal discharge, mild odor, and vaginal irritation. The clinician performs a focused history and pelvic exam and collects a vaginal swab specimen. The specimen is sent to a clinical molecular laboratory for quantitative real-time amplification testing of bacterial DNA markers to assess for bacterial vaginosis (BV) using an algorithmic analysis that integrates patient data and laboratory results. The laboratory performs the technical assay on the vaginal fluid specimen for the six bacterial species specified by 81514, runs the algorithm to report a positive or negative result for high likelihood of BV, and may also report detection of Trichomonas vaginalis and Candida species. Typical workflow: specimen collection in clinic or at a collection site, transport to a reference or hospital molecular lab, processing by a molecular technologist, result generation including algorithmic interpretation, and transmission of results to the ordering provider for clinical management. Typical site of service: outpatient clinic, physician office, community health center, or reference laboratory performing molecular diagnostic testing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 |