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CPT 87190: Mycobacteria Susceptibility Testing, Proportion Method
CPT code 87190 codes for the technical laboratory procedure that evaluates a mycobacteria culture isolate’s susceptibility to an antimicrobial agent using the proportion method. This test is a specialized microbiology service used to guide treatment decisions for mycobacterial infections, including tuberculosis and non-tuberculous mycobacterial disease. Nationally, accurate and standardized susceptibility testing supports appropriate antimicrobial therapy, public health surveillance, and antimicrobial stewardship.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for the service, typical sites of service, and the role of the proportion method in laboratory workflows. The publication also outlines common billing and coding considerations, expected service line placement for reporting, and typical modifiers used with laboratory technical services. Where payer-specific coverage patterns, reimbursement benchmarks, or policy updates exist, those items are summarized to inform billing and administrative teams.
This summary provides clinicians, laboratory managers, and billing professionals with the essential information to identify the procedure represented by CPT code 87190, understand its clinical relevance, and locate areas for further review of payer policies and laboratory protocols. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 87190 describes the laboratory technical procedure for assessing a mycobacteria culture isolate’s susceptibility to an antimicrobial agent using the proportion method. The service focuses on the technical steps performed by a laboratory analyst to determine whether a mycobacterial isolate is sensitive or resistant to a specific antibiotic.
Service type: Microbiology laboratory susceptibility testing (mycobacteria)
Typical site of service: Clinical or reference microbiology laboratory (inpatient or outpatient specimen processing areas)