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    OpenPayerBilling CodesExamination, Homogenization and Concentration ProceduresCPT cpt-87164-dark-field-microscopic-exam-direct-specimen
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    CPT 87164: Dark-Field Microscopy of Direct Specimen

    Medicare pays $19 on average nationally for this procedure.

    CPT code 87164 describes a laboratory procedure in which a lab analyst collects a direct patient specimen (for example, a smear from a penile lesion) and performs a dark-field microscopic examination on a dark background rather than traditional light microscopy; the service type is a direct microscopic diagnostic test and the typical site of service is a clinical laboratory or outpatient collection setting where microscopy of direct specimens is performed.

    For related coverage guidance, see recent payer policy updates: Ambulance and Medical Transport Services (Ground, Air and Water) Corporate Medical Policy, Emergency Air/Water Ambulance Services Medical Guideline, Non-Emergent Ambulance Services.

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    Clinical & Coding Specifications

    Clinical Context

    A sexually active adult male presents to an outpatient sexual health clinic with a painful penile ulcer and reported recent unprotected intercourse. The clinician performs a focused genitourinary exam, documents lesion characteristics, and collects a direct specimen by preparing a smear from the lesion. The laboratory analyst receives the specimen, collects the required material, and performs a microscopic examination using dark-field microscopy to visualize Treponema pallidum or other spirochetes not readily seen on traditional bright-field microscopy. Results are reported to the ordering provider for confirmatory testing (serology or PCR) and subsequent public health reporting if a notifiable infection is identified.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    87070Culture, bacterial; any source, aerobic, other than urine (culture growth, isolated organism, identification not included)May be ordered alongside dark-field microscopy to detect bacterial pathogens from lesion swabs.
    87480Infectious agent detection by nucleic acid (DNA or RNA); Treponema pallidum, amplified probe techniqueOften used as a molecular confirmatory test following a positive or equivocal dark-field exam.
    87164Laboratory collection and microscopic dark-field examination of a direct specimen (e.g., smear from a penile lesion)Primary procedure described; used to visualize spirochetes in direct specimens.
    87210Smear, primary source with interpretation; Gram or Giemsa stainMay be performed on lesion smears for additional microscopic assessment of organisms and inflammatory cells.
    87340Immunoassay for treponemal antibody (e.g., treponemal test)Serologic testing commonly performed in parallel or follow-up to microscopic findings.

    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…
    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…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207RH0000X
    207L00000X
    208000000X
    208D00000X
    2086S0122X
    171000000X
    207N00000X
    174M00000X

    Related ICD-10-CM Codes

    24 rows

    ICD-10-CM CodeDescription
    A49.02Methicillin resistant Staphylococcus aureus infection, unspecified site
    A54.89Other gonococcal infections
    A56.09Other chlamydial infection of lower genitourinary tract
    A59.01Trichomonal vulvovaginitis
    A60.01Herpesviral infection of penis
    A60.9Anogenital herpesviral infection, unspecified
    A63.0Anogenital (venereal) warts
    A64Unspecified sexually transmitted disease
    A74.9Chlamydial infection, unspecified
    B20Human immunodeficiency virus [HIV] disease

    Showing 1–10 of 24

    Related Payer Policy Updates

    Specialty: Emergency & Medical Transportation1 / 3

    10 rows

    PolicyPayerEffective Date
    Ambulance and Medical Transport Services (Ground, Air and Water) Corporate Medical Policybcbsvermont2026-10-01
    Emergency Air/Water Ambulance Services Medical GuidelineWPS Health Insurance2026-10-01
    Non-Emergent Ambulance ServicesConnectiCare2026-09-11
    Fixed Wing Air Ambulance TransportCigna2026-08-15
    Air AmbulanceAmbetter Georgia2026-08-01
    Ambulance Services (for New Mexico Only)UnitedHealthcare2026-08-01
    Ambulance Services (for Tennessee Only)UnitedHealthcare2026-08-01
    Clinical Policy: Air AmbulanceAmbetter Nevada2026-08-01
    Air AmbulanceCentene2026-08-01
    Clinical Policy: Air AmbulanceArizona Complete Health2026-08-01

    Related Codes

    CPT-87166-DARK-FIELD-MICROSCOPY-DIRECT-SPECIMEN

    CPT 87166: Dark-Field Microscopic Exam of Direct Specimen

    CPT-87168-ARTHROPOD-IDENTIFICATION-MACROSCOPIC-EXAM

    CPT 87168: Arthropod Identification, Direct Examination

    CPT-87169-PARASITOLOGY-MACROSCOPIC-EXAMINATION

    CPT 87169: Parasite Identification Without Microscope

    CPT-87172-PINWORM-ADHESIVE-TAPE-EXAMINATION

    CPT 87172: Pinworm Examination by Tape or Paddle

    CPT-87176-TISSUE-HOMOGENIZATION-FOR-CULTURE-PREPARATION

    CPT 87176: Tissue Homogenization for Culture Preparation

    CPT-87177-PARASITOLOGY-STOOL-CONCENTRATION-AND-OVA-EVALUATION

    CPT 87177: Stool Parasite and Ova Concentration and Microscopic Evaluation

    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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