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    v1.0.30
    OpenPayerBilling CodesMicrobiology Culture and Typing ProceduresCPT cpt-87040-blood-culture-isolation-presumptive-identification
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    CPT 87040: Blood Bacterial Culture with Isolation and Presumptive ID

    Commercial payers pay $37 on average nationally for this procedure.

    CPT code 87040 describes a bacterial culture of blood in which the laboratory analyst performs incubation on selected aerobic media and isolates and presumptively identifies any bacterial growth; the code also includes work for anaerobic culture when performed, and represents a microbiology laboratory culture service typically provided as a clinical laboratory diagnostic from hospital laboratories, outpatient laboratory facilities, or other certified clinical lab sites.

    For related coverage guidance, see recent payer policy updates: Long-Acting Injectable Antiretroviral Agents for HIV, B-Hemolytic Streptococcus Testing, Human Immunodeficiency Virus (HIV) — Coverage Criteria for Testing and Resistance Assays.

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    National Reimbursement Benchmarks

    For CPT 87040, BUCA’s average commercial rate sits at $37.2 and provides a useful midpoint for national commercial pricing. Blue Cross Blue Shield displays the highest central tendency with a median of $54.4 and a mean of $56.7, while Aetna and Cigna cluster much lower around medians of $8.5 and $9.3 respectively. UnitedHealth Group also trends low with a median of $6.2. These differences underscore a bifurcated market where BUCA’s average falls between the lower-tier payers (Aetna, Cigna, UnitedHealth Group) and Blue Cross Blue Shield’s higher reimbursements.

    Dispersion measured by the interquartile range (P75–P25) highlights variability: Blue Cross Blue Shield is relatively wide with a range of $28.8 (P75 $69.8 minus P25 $42.1), indicating broader negotiated outcomes, while UnitedHealth Group is the tightest at $5.4 (P75 $10.3 minus P25 $4.6). Aetna’s IQR is $5.4 (P75 $12.0 minus P25 $6.6) and Cigna’s IQR is $9.2 (P75 $15.0 minus P25 $5.8), showing moderate spread; BUCA’s quartiles imply an IQR of $18.7 (P75 $45.2 minus P25 $26.5), reflecting higher-than-average commercial variability around its mean.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old man presents to the emergency department with fever, chills, hypotension, and altered mental status. Blood cultures are ordered prior to empiric intravenous broad-spectrum antibiotics to evaluate for bacteremia and sepsis. A phlebotomist obtains two sets of blood cultures (aerobic and anaerobic bottles) from separate venipuncture sites. The specimens are transported to the hospital clinical microbiology laboratory. A technologist inoculates selected aerobic and anaerobic culture media, incubates bottles, monitors for growth, subcultures any positive bottles, and performs presumptive identification of isolates (colony morphology, biochemical testing, and/or MALDI-TOF if available). Results are reported to the ordering clinician; positive cultures may trigger additional testing such as Gram stain (87205), antimicrobial susceptibility testing (87186), and organism-specific antigen or molecular assays. Typical site of service is the hospital laboratory supporting inpatient or emergency department care; service type is diagnostic microbiology laboratory culture and organism identification. Typical diagnosis codes associated with this scenario include R50.9 (fever), A41.9 (sepsis), and R78.81 (bacteremia).

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    90Modifier ‑90 (Reference/Outside Laboratory) indicates that a laboratory test was performed by an entity other than the treating or reporting provider. The American Medical Association defines…- Use CPT modifier -90 when a laboratory test is performed by an outside/reference laboratory (an entity other than the treating or reporting physician or qualified professional) and the claim needs…
    91Modifier 91 — “Repeat Clinical Diagnostic Laboratory Test” — is appended when the exact same CPT laboratory test is performed more than once for the same patient on the same day because serial,…- Use modifier 91 when the exact same CPT laboratory test is performed more than once on the same patient on the same date because serial or repeated testing is medically necessary to monitor…
    92Modifier 92 (Alternative Laboratory Platform Testing) is used when laboratory tests are performed with single‑use, disposable, portable kits or transportable instruments. The AMA defines it for tests…- Use modifier 92 when a laboratory test is performed using a single‑use, disposable analytical device or kit (an alternative laboratory platform) that is portable and may be taken to or near the…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    291U00000X
    207ZP0102X
    207Q00000X
    207KA0200X
    2472V0600X
    246XC2903X
    213ES0131X
    163WN0003X

    Related ICD-10-CM Codes

    27 rows

    ICD-10-CM CodeDescription
    A40.0Sepsis due to streptococcus, group A
    A41.51Sepsis due to Escherichia coli [E. coli]
    A41.9Sepsis, unspecified organism
    A42.7Actinomycotic sepsis
    A49.9Bacterial infection, unspecified
    A54.89Other gonococcal infections
    B37.7Candidal sepsis
    E11.9Type 2 diabetes mellitus without complications
    F32.9Major depressive disorder, single episode, unspecified
    G00.9Bacterial meningitis, unspecified

    Showing 1–10 of 27

    Related Payer Policy Updates

    Specialty: Infectious Disease1 / 3

    10 rows

    PolicyPayerEffective Date
    Long-Acting Injectable Antiretroviral Agents for HIVColorado Rocky Mountain Health Plans2026-10-01
    B-Hemolytic Streptococcus TestingOscar Health2026-10-01
    Human Immunodeficiency Virus (HIV) — Coverage Criteria for Testing and Resistance AssaysOscar Health2026-10-01
    Hepatitis Testing (A, B, C, D) Coverage CriteriaOscar Health2026-10-01
    Lyme Disease Testing Coverage CriteriaOscar Health2026-10-01
    Pathogen Panel TestingOscar Health2026-10-01
    Diagnostic Testing of Common Sexually Transmitted InfectionsOscar Health2026-10-01
    Coronavirus Testing in the Outpatient SettingOscar Health2026-10-01
    Testing for Vector-Borne InfectionsOscar Health2026-10-01
    Testing for Diagnosis of Active or Latent TuberculosisOscar Health2026-10-01

    Related Codes

    87086-CULTURE-BACTERIAL-QUANTITATIVE-COLONY-COUNT

    CPT 87086: Urine Culture with Quantitative Colony Count

    CPT-87045-AEROBIC-BACTERIAL-STOOL-CULTURE-SALMONELLA-SHIGELLA

    CPT 87045: Aerobic Bacterial Stool Culture for Salmonella/Shigella

    CPT-87046-AEROBIC-BACTERIAL-STOOL-CULTURE-PRESUMPTIVE-ID-NON-SALMONELLA-SHIGELLA

    CPT 87046: Aerobic Bacterial Stool Culture, Presumptive ID (non-Salmonella/Shigella)

    CPT-87070-AEROBIC-CULTURE-ISOLATION-PRESUMPTIVE-IDENTIFICATION

    CPT 87070: Aerobic Culture with Isolation and Presumptive Identification

    CPT-87071-AEROBIC-QUANTITATIVE-BACTERIAL-CULTURE-NON-URINE-BLOOD-STOOL

    CPT 87071: Quantitative Aerobic Bacterial Culture, Non-urine/blood/stool

    CPT-87073-ANAEROBIC-CULTURE-NONBLOOD-NONURINE-NONSTOOL

    CPT 87073: Anaerobic Culture, Non-Urine/Blood/Stool

    CPT-87075-ANAEROBIC-CULTURE-IDENTIFICATION-NON-BLOOD-SPECIMEN

    CPT 87075: Anaerobic Culture and Bacterial Identification (Nonblood)

    CPT-87076-ANAEROBIC-ISOLATE-DEFINITIVE-IDENTIFICATION

    CPT 87076: Anaerobic Isolate Identification to Species Level

    CPT-87077-DEFINITIVE-IDENTIFICATION-AEROBIC-ISOLATE

    CPT 87077: Definitive Identification of Aerobic Isolate

    CPT-87081-TARGETED-SINGLE-ORGANISM-CULTURE

    CPT 87081: Selective Culture for Specific Pathogen

    Showing 1–10 of 30

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    87070Culture, bacterial; any other source, with isolation and presumptive identification of isolatesAlternative culture code used for non-blood sources (wound, urine, sputum); may be billed when isolates are recovered from other specimen types in the same clinical episode.
    87186Susceptibility studies, antimicrobial agent; microdilution or agar dilution (MIC or breakpoint), each multi-antimicrobial agent panelPerformed after isolation to determine antimicrobial susceptibilities for bacterial isolates identified from blood culture.
    87205Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell typesPerformed on positive culture material or primary specimen to provide rapid Gram stain information to clinicians while cultures incubate.
    87880Infectious agent detection by immunoassay with direct optical observation; Streptococcus, group AExample of organism-specific rapid antigen testing that may be used for other specimen types; not typically used for blood but relevant in differential diagnostic workflows.