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 |
59 | Distinct procedural service | When a separate, distinct diagnostic test or specimen collection is performed on the same date requiring separate reporting |
90 | Reference (outside) laboratory | When the test is performed by an outside reference laboratory and only the ordering lab bills |
91 | Repeat clinical diagnostic test | When the same test is repeated on the same day to confirm a result (Note: 91 is not listed in input modifiers; use 90 and 59 instead as applicable) |
52 | Reduced services | When the test is partially reduced or not fully completed as originally described |
53 | Discontinued procedure | When specimen processing is terminated prior to completion for valid clinical reasons |
76 | Repeat procedure by same physician | For repeat testing ordered and performed by the same lab/provider (not in provided list) |
77 | Repeat procedure by another physician | For repeat testing performed by a different lab/provider (not in provided list) |
QK | CLIA waived test performed by a lab personnel under limited CLIA personnel requirements | When applicable personnel qualifications affect billing for testing |
QX | CLIA waived test performed by a qualified lab director | When test meets CLIA criteria and specific personnel performed it |
QY | CLIA waived test performed by a physician or midlevel provider | When billing requires indicating provider type for the CLIA test |
90 | Outside lab (duplicate entry avoided) | See above |
59 | Distinct procedural service (duplicate entry avoided) | See above |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207RC0000X | Infectious Disease | Specialists order and interpret viral diagnostic testing for complex cases |
208000000X | Pathology | Pathologists oversee laboratory testing protocols and interpretations |
363L00000X | Clinical Laboratory | Clinical laboratory directors and personnel perform and bill immunofluorescent assays |
207Q00000X | Pediatrics | Pediatricians commonly order adenovirus testing for children with conjunctivitis or respiratory illness |
207P00000X | Otolaryngology (ENT) | ENTs may order testing for patients with pharyngitis or sinus/ear complications |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
B97.2 | Adenovirus as the cause of diseases classified elsewhere | Directly indicates adenoviral etiology when confirmed by 87260 |
H10.9 | Conjunctivitis, unspecified | Common presentation prompting adenovirus antigen testing from conjunctival swabs |
J02.9 | Acute pharyngitis, unspecified | Sore throat presentations where adenovirus testing from throat swabs may be indicated |
J00 | Acute nasopharyngitis (common cold) | Upper respiratory symptoms where clinicians may include adenovirus in viral testing panels |
J18.9 | Pneumonia, unspecified organism | Lower respiratory infection where adenovirus may be considered and tested for in hospitalized patients |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
87070 | Culture, bacterial; any source, other than urine, except blood, with isolation and presumptive identification of each organism recovered | May be used when bacterial culture is indicated in addition to viral antigen testing for conjunctival or respiratory infections |
87804 | Infectious agent antigen detection by immunoassay with direct optical observation; respiratory syncytial virus (RSV) | Performed alongside viral antigen panels when differential viral diagnosis is needed in respiratory illness |
87901 | Infectious agent detection by nucleic acid (DNA or RNA); adenovirus, direct probe technique | Molecular testing alternative or confirmatory method to 87260 for adenovirus detection |
87480 | Infectious agent detection by nucleic acid; adenovirus, amplified probe technique | Higher-sensitivity molecular assay often used after or instead of immunofluorescent antigen testing |
99000 | Handling and/or conveyance of specimen | Used when special specimen handling or courier services are billed in conjunction with laboratory testing |
99001 | Educational services related to procedure (example) | May apply when documentation of patient education or counseling accompanies diagnostic testing workflows |