Summary & Overview
CPT 87116: AFB Culture and Identification, Genus Level
CPT code 87116 denotes a laboratory culture and identification procedure for acid-fast bacilli (AFB), including tubercle bacilli detection to the genus or least specific level. This code captures a crucial diagnostic step for suspected mycobacterial infections, including tuberculosis, that has national clinical and public health importance because accurate identification guides infection control, treatment decisions, and public health reporting. Major national payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise explanation of the clinical context for AFB culture and identification, the typical laboratory and hospital settings where the service is provided, and the role of this code in diagnostic workflows. The publication summarizes common payer coverage considerations and benchmarks, highlights relevant coding and billing guidance where available, and outlines recent policy or payment updates that affect laboratory services for mycobacterial testing. The content is intended for billing professionals, laboratory managers, and policy analysts seeking a national-level reference on coding, clinical use, and payer treatment of CPT code 87116.
Billing Code Overview
CPT code 87116 describes a laboratory culture and identification of acid-fast bacilli (AFB), including detection of tubercle bacilli (the bacteria that cause tuberculosis) to the least specific taxonomic level such as genus. The service involves a laboratory analyst performing culture procedures on material from any source and identifying any isolated tubercle or other AFB organisms.
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Service type: Microbiology laboratory culture and organism identification
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Typical site of service: Clinical laboratory or hospital laboratory setting
Data not available in the input for payers, taxonomies, and ICD-10 diagnoses.
Clinical & Coding Specifications
Clinical Context
A patient presents to an outpatient infectious disease clinic or hospital inpatient unit with symptoms suggesting active mycobacterial infection (for example, persistent cough, weight loss, night sweats, fever, or an unexplained pulmonary infiltrate). A specimen such as sputum, bronchoalveolar lavage, tissue biopsy, or other body fluid is collected and sent to the microbiology laboratory. The laboratory analyst performs a culture specifically to recover tubercle bacilli or other acid-fast bacilli (AFB). Cultures are incubated on appropriate media and processed until growth is detected or the culture is finalized as no growth. Any isolated AFB are identified to the least specific level (for example, genus) using biochemical tests, molecular methods, or mass spectrometry as available. Results are reported to the ordering clinician and used to guide infection control, public health reporting, and antimicrobial therapy decisions. Typical sites of service include hospital microbiology laboratories, public health laboratories, and outpatient reference laboratories.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the professional (interpretation) portion of a test provided by an independent laboratory or separate provider. |
TC |