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CPT 87040: Blood Culture with Isolation and Presumptive Identification
CPT code 87040 represents a bacterial blood culture with isolation and presumptive identification of any organisms that grow, and includes anaerobic culture work when performed. This laboratory procedure is a core diagnostic service for detecting bacteremia and guiding antimicrobial management, making it nationally significant for hospitals, clinical laboratories, and acute care settings that diagnose sepsis and bloodstream infections. Key payers in the coverage landscape include Aetna, Blue Cross Blue Shield plans, Cigna Health, United Healthcare, and Medicare.
Readers will find a concise overview of the clinical purpose and typical settings for CPT code 87040, comparisons to related laboratory codes, and operational considerations relevant to billing and claims processing. The publication summarizes common payer coverage approaches, coding relationships with related microbiology and susceptibility codes, and clinical contexts in which the test is commonly reported (for example, evaluation of suspected sepsis, fever with unknown source, or suspected bacteremia). The report does not provide clinical recommendations but supplies context for reimbursement coding, common service combinations, and typical diagnostic indications tied to this laboratory procedure.
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Billing Code Overview
CPT code 87040 describes a laboratory procedure in which a lab analyst performs a bacterial culture of blood and isolates and presumptively identifies bacteria that grow on selected aerobic media. The code also includes work for anaerobic culture when that testing is performed. The service is a clinical microbiology laboratory diagnostic procedure.
Service type: Bacterial blood culture with isolation and presumptive identification
Typical site of service: Clinical laboratory or hospital laboratory (inpatient or outpatient settings where blood cultures are collected and processed)
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.