Summary & Overview

CPT 87109: Culture and Identification of Mycoplasma

Headline: CPT code 87109: Laboratory Culture and Identification of Mycoplasma

Lead: CPT code 87109 covers laboratory culture and identification of mycoplasma from any patient specimen—a specialized microbiology service with implications for infectious disease diagnosis and public health surveillance.

CPT code 87109 represents a microbiology laboratory test in which a culture is performed on a specimen from any patient source to detect and identify mycoplasma organisms. This service supports diagnosis of respiratory, urogenital, and other mycoplasma-associated infections and can influence clinical management and infection control decisions. Nationally, availability of accurate mycoplasma culture and identification affects diagnostic capacity and laboratory workflows.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The review addresses payer coverage patterns, clinical context, and typical laboratory settings where the service is delivered.

Readers will learn the clinical purpose of the code, the service and site-of-service context, and what to expect in a national policy and billing overview. The document provides benchmarks and operational context where available and notes when input data is not provided. Data not available in the input is identified explicitly.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare87109CPTmicrobiologymycoplasmalaboratorycultureidentificationclinical-laboratory

Billing Code Overview

CPT code 87109 describes a laboratory procedure in which a lab analyst performs a culture from any patient source and identifies any mycoplasma. This is a microbiology culture and identification service focused on detection of mycoplasma organisms.

Service type: Laboratory / Microbiology testing

Typical site of service: Clinical laboratory, hospital laboratory, or reference laboratory

Clinical & Coding Specifications

Clinical Context

A typical patient is a 24-year-old presenting to an outpatient infectious disease or primary care clinic with symptoms of persistent non-productive cough, low-grade fever, and malaise for two weeks after recent college dorm exposure. The clinician performs a focused history and physical exam, documents suspected atypical pneumonia, and orders diagnostic testing. A respiratory specimen (oropharyngeal/nasopharyngeal swab or sputum) is collected in the clinic or emergency department and sent to the clinical microbiology laboratory. In the laboratory, an analyst performs culture techniques and organism identification specifically targeted to detect Mycoplasma species. Results are reported in the electronic medical record and communicated to the ordering provider for antimicrobial management decisions.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when reporting only the professional (interpretation) component if the lab charges separately for interpretation.
`TC`	Technical component	Use when reporting only the technical component (laboratory processing) of the test.
`59`	Distinct procedural service	Use when the mycoplasma culture is a separate and distinct service from other laboratory procedures performed the same day.
`90`	Reference (outside) laboratory	Use when the specimen is sent to an outside reference laboratory for testing.
`91`	Repeat clinical diagnostic test	Use when the test is repeated on the same day for serial comparison (report only when appropriate).
`52`	Reduced services	Use when the lab performed a reduced service compared with the full procedure.
`53`	Discontinued procedure	Use if specimen processing was started but discontinued due to circumstances that precluded completion.
`59`	Distinct procedural service	Use when the culture is distinct from other services on the same date (listed above for emphasis).
`78`	Unplanned return to the operating/procedure room	Generally not applicable but retained for scenarios where intra-procedure lab work occurs after a return to procedure room.
`90`	Reference (outside) laboratory	(Repeated to show relevance for outside send-outs.)

Taxonomy Code	Specialty	Notes
208000000X	Pathology	Clinical microbiologists and pathology services that perform microbiology cultures.
207Q00000X	Infectious Disease	Specialists who order targeted mycoplasma testing and interpret results for management.
207R00000X	Family Medicine	Primary care physicians who collect specimens and order tests for community respiratory infections.
208000000X-0001	Medical Laboratory Technologist	Laboratory personnel performing cultures and organism identification.
207L00000X	Internal Medicine	Hospitalists and internists who order and use results for inpatient respiratory illness management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`J18.9`	Pneumonia, unspecified organism	Common presenting diagnosis for patients undergoing respiratory pathogen testing, including mycoplasma culture.
`J15.9`	Pneumonia due to unspecified bacterial organism	Used when bacterial pneumonia is suspected and cultures are obtained to identify pathogen.
`J02.9`	Acute pharyngitis, unspecified	Upper respiratory specimens for culture may be collected when mycoplasma is considered in pharyngitis.
`R05`	Cough	Symptom code often associated with ordering respiratory cultures for suspected atypical pathogens.
`B95.3`	Streptococcus pneumoniae as the cause of diseases classified elsewhere	May be used as a secondary code when culture identifies bacterial pathogens; included here as a commonly linked code in culture workflows.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`87070`	Culture, bacterial; any other source except urine, aerobic, with isolation and presumptive identification of isolates	Often performed alongside or prior to targeted mycoplasma testing when bacterial pathogens are also suspected.
`87205`	Smear, primary source with interpretation; gram stain, each smear	May be performed on respiratory specimens to provide rapid preliminary information while cultures incubate.
`87210`	Smear, primary source with interpretation; trichrome or other special stains	Used when special staining techniques are needed for organism visualization in respiratory samples.
`87480`	Infectious agent detection by nucleic acid (DNA or RNA), amplified probe technique, qualitative, multiplex, etc.	Molecular testing for Mycoplasma pneumoniae is commonly ordered as a faster alternative or adjunct to culture.
`87798`	Infectious agent antigen detection by immunoassay technique, multiple-step method, each reagent lot	Antigen or immunoassay tests may be used in conjunction with culture for pathogen detection.