Summary & Overview
CPT 87172: Pinworm (Adhesive Tape) Microscopic Examination
CPT code 87172 covers microscopic examination of specimens collected with a pinworm paddle or transparent adhesive tape to detect pinworm eggs or adults. This focused parasitology test is important for confirming enterobiasis, guiding treatment decisions, and reducing transmission in community and household settings. Nationally, accurate coding and documentation for this low-complexity laboratory procedure supports surveillance, appropriate therapy, and public-health reporting where required.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, common modifier use (where provided), and payer considerations. The publication highlights reimbursement benchmarking, coding guidance, and operational notes relevant to laboratories and outpatient testing sites. It also outlines what to expect in claims submission and common areas for documentation review.
This summary is intended for laboratory managers, coding and billing professionals, and clinicians overseeing diagnostic testing workflows who need a national perspective on clinical use, coding practice, and payer coverage considerations for CPT code 87172.
Billing Code Overview
CPT code 87172 describes laboratory examination of a specimen collected with a pinworm paddle or transparent adhesive tape to identify pinworm eggs or adult organisms. This service is a direct parasitology test performed by a laboratory analyst to detect Enterobius vermicularis (pinworm) infestation.
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Service type: Laboratory parasitology examination
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Typical site of service: Clinical laboratory or outpatient laboratory setting
Clinical & Coding Specifications
Clinical Context
A child or adult presents to a primary care clinic or outpatient pediatric clinic with perianal itching, nocturnal anal pruritus, or household exposure to Enterobius vermicularis (pinworm). The clinician instructs the caregiver or patient on collecting a specimen using a pinworm paddle or transparent adhesive tape applied to the perianal area first thing in the morning before bathing or toileting. The specimen is submitted to the clinic laboratory or an external reference lab. A laboratory technologist or microscopist performs 87172 by mounting the adhesive sample on a slide and examining it under light microscopy for pinworm eggs or adult worms. Results are documented in the laboratory report and communicated to the ordering clinician for treatment decisions and contact tracing within the household. Typical sites of service are outpatient clinic, pediatrician office, urgent care, and hospital outpatient laboratory when samples are collected on-site.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Office or other outpatient visit, new or established | Use when the service is furnished in an outpatient clinic setting and reporting office visit as primary service (if payer requires modifier). |
26 |