Summary & Overview
CPT 87260: Adenovirus Antigen Detection by Immunofluorescence
CPT code 87260 represents an immunofluorescent laboratory test for detection of adenovirus antigens. This laboratory procedure is used to identify adenoviral infection by visualizing viral antigens in respiratory or other clinical specimens and is important for clinical diagnosis, infection control decisions, and appropriate patient management. Nationally, accurate coding and use of antigen-detection assays affect surveillance, laboratory workflow, and payer coverage decisions for viral diagnostics.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise guide to clinical context, coding considerations, common modifiers, and payer coverage patterns where available.
Readers will learn the clinical purpose of the test, typical sites of service, and the operational context for billing CPT code 87260. The report outlines common modifier usage (list provided), highlights where data are available or missing, and explains what benchmarks and policy updates would be relevant for laboratory administrators and billing professionals. Data not available in the input are noted explicitly where applicable.
Billing Code Overview
CPT code 87260 describes a laboratory procedure in which a laboratory analyst performs an immunofluorescent test to detect adenovirus antigens. The service is a pathology/laboratory diagnostic test that identifies viral antigens in clinical specimens using immunofluorescence techniques.
Service Type: Pathology / Laboratory — Immunofluorescent Viral Antigen Detection
Typical Site of Service: Clinical laboratory or hospital laboratory
Clinical & Coding Specifications
Clinical Context
A child or adult presents to an urgent care clinic or hospital outpatient laboratory with acute onset of conjunctivitis, pharyngitis, or respiratory symptoms such as cough, fever, and rhinorrhea. The clinician collects a nasopharyngeal swab, conjunctival swab, or throat specimen and sends it to the laboratory for direct antigen detection. The laboratory analyst performs an immunofluorescent assay to detect adenovirus antigen from the clinical specimen using 87260. Results are reported to the ordering clinician to guide infection control, cohorting, and antiviral or supportive care decisions. Typical sites of service include hospital outpatient laboratories, community hospital inpatient labs, urgent care centers, and specialty ophthalmology or ENT clinics with laboratory support.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting only the professional interpretation component if separated from the technical component |
TC | Technical component | When reporting only the laboratory technical component of the test |