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.
Data not available in the input.
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. |
90 | Reference (outside) laboratory | Use when the specimen is sent to an outside independent laboratory and billed by the performing lab. |
91 | Repeat clinical diagnostic test (Note: not in provided list) | Data not available in the input. |
52 | Reduced services | Use when the test is partially reduced or not performed to full protocol. |
53 | Discontinued procedure | Use when testing was started but discontinued for documented clinical reasons. |
59 | Distinct procedural service (Note: not in provided list) | Data not available in the input. |
90 | Reference (outside) laboratory | Duplicate entry removed; only single entry should be used. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 1223P0001X | Clinical Laboratory Director | Oversees laboratory testing and quality control for immunofluorescent assays. |
| 207L00000X | Infectious Disease Specialist | Orders and interprets pertussis testing in complex cases and public health follow-up. |
| 207P00000X | Pediatrician | Frequently evaluates children with cough and orders diagnostic testing for pertussis. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
A37.0 | Whooping cough due to Bordetella pertussis | Primary diagnosis prompting antigen testing by 87265. |
A37.1 | Whooping cough due to Bordetella parapertussis | Alternate Bordetella species detected by the immunofluorescent assay. |
R05 | Cough | Common presenting symptom that leads clinicians to order pertussis testing. |
R50.9 | Fever, unspecified | Associated symptom that may accompany pertussis infection and justify diagnostic testing. |
J06.9 | Acute upper respiratory infection, unspecified | Differential diagnosis when evaluating a patient with cough; testing helps distinguish pertussis. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
87265 | Antigen detection by immunofluorescent technique for Bordetella pertussis/ parapertussis | Primary test performed to detect pertussis antigens from respiratory specimens. |
87420 | Infectious agent detection by nucleic acid (DNA or RNA); Bordetella pertussis, direct probe technique | Alternative molecular test often ordered for higher sensitivity; may be performed alongside or instead of 87265. |
87650 | Infectious agent detection by nucleic acid (DNA or RNA); respiratory syncytial virus | Other respiratory pathogen testing that may be ordered concurrently in patients with respiratory symptoms. |
87070 | Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates | Growth-based testing that can be used to confirm Bordetella species when available, often performed after initial antigen or molecular tests. |