Summary & Overview
CPT 87265: Immunofluorescent Antigen Detection for Bordetella
CPT code 87265 denotes an immunofluorescent antigen detection test for Bordetella pertussis and Bordetella parapertussis. This laboratory procedure is clinically important for confirming pertussis (whooping cough) infections, guiding public health responses, and informing treatment and prophylaxis decisions. Nationally, accurate and timely diagnostic coding for infectious disease testing supports surveillance, reimbursement consistency, and laboratory workflow standardization.
Key payers considered in this context include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarks for coding and utilization, common payer coverage considerations, clinical context for when immunofluorescent antigen testing is used versus other diagnostic modalities, and operational notes on typical sites of service. The summary highlights where policy updates or payer-specific coverage rules may affect billing and claims adjudication. Where specific payer policy data or associated taxonomies and ICD-10 pairings are not provided, the report notes that those items are not available in the input.
Billing Code Overview
CPT code 87265 describes a laboratory test in which a laboratory analyst detects Bordetella pertussis and Bordetella parapertussis antigens using an immunofluorescent technique. The service type is infectious disease diagnostic testing — antigen detection by immunofluorescence. The typical site of service is a clinical laboratory or hospital laboratory performing microbiology or infectious disease testing.
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Clinical & Coding Specifications
Clinical Context
A pediatric patient aged 2 years presents to an urgent care clinic with a 10-day history of paroxysmal coughing, posttussive vomiting, and occasional inspiratory whoop. The clinician performs a focused respiratory exam and suspects pertussis (whooping cough). Nasopharyngeal swab specimens are collected and sent to the laboratory for rapid antigen detection using an immunofluorescent technique. In the lab, a trained medical technologist or lab analyst performs 87265 to detect Bordetella pertussis and Bordetella parapertussis antigens by immunofluorescence. Results are reported to the ordering provider to guide infection control, public health reporting, and targeted antibiotic therapy if indicated. Typical sites of service include outpatient clinics, urgent care centers, hospital outpatient departments, and public health laboratories.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation component separate from the technical component. |
TC | Technical component | Use when billing only the technical component (laboratory processing and reagents) without professional interpretation. |