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    OpenPayerBilling CodesPrimary Source Smear ProceduresCPT cpt-87207-slide-analysis-for-inclusion-bodies-primary-source
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    CPT 87207: Slide Analysis for Inclusion Bodies

    Medicare pays $18 and commercial payers pay $32 on average nationally for this procedure.

    CPT code 87207 describes a technical laboratory procedure in which a lab analyst examines a primary-source specimen prepared on a slide to detect and analyze intracellular inclusion bodies; service type: microscopic slide analysis / parasitology/virology cytology, typical site of service: clinical laboratory or hospital laboratory.

    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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    National Reimbursement Benchmarks

    Across national payers, Medicare’s mean rate of $18.2 sits below BUCA’s average commercial mean of $31.7, indicating that BUCA reimburses substantially higher on average for CPT 87207 than Medicare. Blue Cross Blue Shield’s mean of $46.5 and Cigna’s mean of $17.1 further highlight commercial variability, with BCBS above BUCA and Cigna closer to Medicare. UnitedHealth Group ($9.0) and Aetna ($9.8) cluster lower among commercial payers, producing a broad span of typical commercial reimbursements around the Medicare baseline.

    Dispersion measured by the interquartile range (P75–P25) is widest for Blue Cross Blue Shield at $33.9 and relatively wide for BUCA at $22.3, signaling considerable variability in commercially negotiated rates. The tightest spreads are Medicare at $1.0 (P75–P25 = $1) and UnitedHealth Group at $7.8, with Aetna ($9.6) and Cigna ($14.7) in between. This suggests some payers deliver consistent rates around their medians while others have much broader negotiated ranges.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 28-year-old patient presents to a family medicine clinic with sore throat, fever, and purulent pharyngeal exudate. A clinician collects a direct swab from the oropharynx (a primary source) and sends the slide to the affiliated clinical laboratory for microscopic examination for inclusion bodies and other cytopathic changes. In the laboratory, a technologist or lab analyst performs the technical microscopy procedure described by 87207 to prepare and analyze the specimen on a slide. Findings help distinguish viral cytopathic effect (inclusion bodies) versus bacterial or fungal etiologies and guide subsequent confirmatory testing such as culture or molecular assays. Typical workflow: clinician encounter and specimen collection in an outpatient clinic or emergency department; specimen transported to an on-site or reference clinical laboratory (Clinical Laboratory or Pathology setting) for slide preparation and analysis; results reported back to the ordering provider to inform diagnosis and next steps (e.g., culture 87070, wet mount 87210, or targeted molecular tests). Typical sites of service include ambulatory clinics, urgent care centers, hospital outpatient departments, and hospital laboratories. The common clinical indications include evaluation of acute pharyngitis (J02.9), suspected respiratory infection such as pneumonia (J18.9), nonspecific bacterial infection (A49.9), mucosal candidiasis (B37.9), and enteric symptoms with stool involvement such as diarrhea (R19.7) when a direct smear of a primary source specimen is performed.

    Related CPT Codes

    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…
    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…
    91Modifier 91 — “Repeat Clinical Diagnostic Laboratory Test” — is appended when the exact same CPT laboratory test is performed more than once for the same patient on the same day because serial,…- Use modifier 91 when the exact same CPT laboratory test is performed more than once on the same patient on the same date because serial or repeated testing is medically necessary to monitor…
    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…
    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…
    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…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    291U00000X
    207ZP0102X
    207Q00000X
    207YS0012X
    261QR0208X
    204E00000X
    102L00000X
    2084P0005X

    Related ICD-10-CM Codes

    5 rows

    ICD-10-CM CodeDescription
    A49.9Bacterial infection, unspecified
    B37.9Candidiasis, unspecified
    J02.9Acute pharyngitis, unspecified
    J18.9Pneumonia, unspecified organism
    R19.7Diarrhea, unspecified

    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-87205-GRAM-GIEMSA-STAIN-PRIMARY-SOURCE

    CPT 87205: Gram or Giemsa Stain with Interpretation

    CPT-87206-FLUORESCENT-ACID-FAST-STAIN-MICROSCOPY

    CPT 87206: Fluorescent/Acid-Fast Stain Microscopy

    CPT-87209-OVA-AND-PARASITE-COMPLEX-SPECIAL-STAIN

    CPT 87209: Complex Special Stain for Ova and Parasites

    CPT-87210-WET-MOUNT-PREPARATION-MICROSCOPY

    CPT 87210: Wet Mount Preparation and Microscopic Examination

    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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    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    CPT CodeDescriptionRelationship to This Procedure
    87070Culture, bacterial; any other source except urine, blood or stoolPerformed when a bacterial culture is needed following microscopic findings on the primary source slide analyzed by 87207.
    87177Ova and parasites, direct smears, concentration and identificationRelated when parasitic organisms are suspected on direct smears from primary source specimens; different laboratory method but may follow initial microscopy.
    87210Smear, primary source with interpretation; wet mount for infectious agentsAlternative or complementary direct smear procedure with interpretation; may be performed in conjunction or as a follow-up to 87207.
    87491Chlamydia trachomatis, amplified probe techniqueMolecular testing that may be ordered after initial microscopic assessment if sexually transmitted infection is suspected from a primary source specimen.