Summary & Overview
CPT 87101: Mycology Culture and Identification from Skin, Hair, or Nail
CPT code 87101 covers laboratory mycology culture and identification from skin, hair, or nail specimens, reporting organism identification to the least specific level (for example, genus). This code matters nationally because fungal skin, hair, and nail infections are common outpatient and inpatient diagnostic concerns that drive laboratory utilization and affect antimicrobial management. Major payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of clinical context for fungal cultures, typical sites of service, and common billing considerations tied to CPT code 87101. The publication summarizes benchmarks for laboratory utilization and reimbursement patterns, highlights relevant coding and billing nuances for labs and hospital laboratories, and outlines policy or payer updates that affect coverage and claim adjudication. It also provides guidance on where CPT code 87101 sits among related laboratory services and what operational stakeholders should expect when ordering or processing these tests. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 87101 describes a laboratory procedure in which a lab analyst performs a culture using material from skin, hair, or nail and identifies any isolated fungus to the least specific level, such as genus. This service is a microbiology mycology culture and identification procedure.
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Service type: Laboratory diagnostic mycology culture and organism identification
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Typical site of service: Clinical laboratory or hospital laboratory setting
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Clinical & Coding Specifications
Clinical Context
A patient presents to an outpatient dermatology clinic with a 3-week history of an enlarging, pruritic, scaly lesion of a toenail and adjacent skin. The clinician performs a focused exam, documents suspicion for a dermatophyte infection (tinea pedis/onychomycosis), and collects specimen material from the nail and adjacent skin by scraping and clipping. The specimen is submitted to the clinical laboratory for fungal culture and identification. In the lab, a microbiology technologist inoculates appropriate media, incubates cultures, observes growth over days to weeks, and identifies any isolated fungus to the least specific level (for example, genus), as described by 87101. Results are reported to the ordering clinician and entered into the electronic medical record; results guide antifungal therapy selection and duration. Typical sites of service include outpatient dermatology clinics, podiatry offices, urgent care centers, and hospital clinical laboratories when inpatient specimens are submitted.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the professional interpretation component separate from the technical lab work (rare for microbiology cultures). |