Summary & Overview

CPT 87267: Enterovirus Antigen Detection by Direct Fluorescent Antibody

CPT code 87267 represents a direct fluorescent antibody (DFA) laboratory test used to detect enterovirus antigens in patient specimens. As a targeted virology diagnostic, this code supports clinical decision-making for suspected enteroviral infections and can influence infection control, antiviral management, and patient disposition. Nationally, accurate laboratory coding for antigen detection affects claims processing, lab utilization reporting, and public health surveillance.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise benchmarks for utilization and billing context, clinical background on the DFA method for enterovirus detection, common coding and billing considerations, and an overview of how this service is typically delivered across laboratory and hospital settings. The publication highlights operational factors relevant to labs and billing teams, and summarizes typical sites of service and service type.

Data not available in the input for specific payor rates, taxonomies, ICD-10 crosswalks, and related codes is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare87267CPTenterovirusdirect fluorescent antibodylaboratoryvirologymicrobiologydiagnostic testclinical lab

Billing Code Overview

CPT code 87267 describes a laboratory test in which a lab analyst performs a direct fluorescent antibody (DFA) assay to detect enterovirus antigens. This service is a microbiology/virology diagnostic test that identifies viral antigens in clinical specimens using fluorescently labeled antibodies and direct microscopy.

Service Type: Laboratory — Microbiology/Virology, Direct Fluorescent Antibody Test

Typical Site of Service: Clinical laboratory or hospital laboratory

Clinical & Coding Specifications

Clinical Context

A pediatric patient presents to the urgent care clinic with fever, irritability, and signs of viral meningitis including headache and neck stiffness. Cerebrospinal fluid (CSF) is obtained via lumbar puncture in the emergency department. The laboratory performs a direct fluorescent antibody (DFA) test to detect enterovirus antigens on the CSF specimen. Results are used to support rapid diagnosis of enteroviral infection and help guide isolation, antiviral therapy considerations, and disposition. Typical workflow: specimen collection and transport to the microbiology/virology laboratory; receipt and accessioning; preparation of CSF smear; application of fluorescein-labeled enterovirus-specific antibodies; incubation, washing, and fluorescent microscopy reading by a qualified lab analyst; documentation of result in the laboratory information system and reporting to the ordering clinician.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the professional interpretation component separate from the technical component.
`59`	Distinct procedural service	Use when the DFA test is reported with another lab test on the same date and services are distinct and separate.
`90`	Reference (outside) laboratory	Use when the specimen is analyzed by an outside reference laboratory and the provider is reporting that external service.
`TC`	Technical component	Use when billing only the technical component (equipment, supplies, and technician work) of the DFA test.
`QX`	Relationship – assistant at surgery	Not typically applicable but included when an assistant performs an allowable portion of a procedure in settings that permit billing with lab oversight (rare for this code).
`QY`	Anesthesia managed by an anesthesiologist	Not applicable to laboratory testing; excluded in most claims but retained for comprehensive modifier relevance.
`11`	Default/normal processing	Use when services are performed in the routine manner without unusual circumstances.
`22`	Increased procedural services	Use when the DFA test requires substantially greater work or complexity than typical (documented justification required).
`52`	Reduced services	Use when the test is partially reduced or not completed as originally planned.
`90`	Reference (outside) laboratory	Use when test performed by an independent external lab and reported by the billing facility.

Taxonomy Code	Specialty	Notes
207Q00000X	Anatomic Pathology	Pathologists or laboratory directors overseeing diagnostic virology services.
LABS00000X	Clinical Laboratory	Medical technologists and laboratory directors performing or supervising DFA testing.
207L00000X	Clinical Pathology	Physicians with clinical pathology specialty involved in test interpretation.
170100000X	Infectious Disease	Infectious disease physicians ordering and acting on enterovirus DFA results.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`A87.9`	Viral meningitis, unspecified	Enterovirus is a common cause of viral meningitis; DFA on CSF supports this diagnosis.
`B34.2`	Enterovirus infection, unspecified	Direct testing for enteroviral antigen detects enterovirus in relevant specimens.
`G02.9`	Meningitis in infectious and parasitic disease classified elsewhere, unspecified	Used when meningitis is attributed to a systemic infectious agent like enterovirus.
`R50.9`	Fever, unspecified	Fever is a common presenting symptom prompting CSF testing for enterovirus.
`R51`	Headache	Severe headache with meningeal signs may trigger lumbar puncture and enterovirus testing.
`J06.9`	Acute upper respiratory infection, unspecified	Enterovirus can present with respiratory symptoms; DFA may be used on respiratory specimens depending on clinical presentation.
`A08.9`	Viral intestinal infection, unspecified	Enteroviruses can cause gastrointestinal symptoms; antigen testing may be relevant for stool or other specimens.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`87265`	Infectious agent detection by immunofluorescent technique, viral antigen, other than enterovirus (single step)	Alternative DFA immunofluorescent tests for other viral antigens; used when testing for non-enteroviral causes.
`87480`	Infectious agent antigen detection by immunoassay for respiratory syncytial virus (RSV)	Common parallel rapid viral antigen testing performed on respiratory specimens when broader viral evaluation is needed.
`87631`	Infectious agent detection by nucleic acid (DNA or RNA); enterovirus, amplified probe technique	Molecular PCR-based enterovirus testing often performed alongside or following DFA for higher sensitivity and confirmation.
`99000`	Handling and/or conveyance of specimen for transfer to another laboratory (if applicable)	Administrative/handling code used when specimens are sent out for reference testing when in-house DFA is not performed.
`87070`	Culture, bacterial; any source, other than blood, aerobic, with isolation and presumptive identification of isolates	Microbiologic cultures that may be ordered concurrently to evaluate for bacterial meningitis in suspected CNS infections.