Summary & Overview
CPT 87272: Cryptosporidium Antigen Immunofluorescent Test
CPT code 87272 denotes an immunofluorescent laboratory test to detect Cryptosporidium antigens, a diagnostic assay used to identify a common protozoal cause of diarrheal illness. Nationally, accurate and timely detection of Cryptosporidium supports public health surveillance, infection control, and appropriate clinical management of gastrointestinal infections. The code is relevant to hospital and outpatient clinical laboratories that perform stool antigen testing using fluorescent-tagged antibodies.
Key payers considered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical purpose of the test, typical sites of service, and the operational context for laboratories reporting this code. The publication covers reimbursement benchmarks where available, coding and billing considerations relevant to laboratory services, and clinical context for when an immunofluorescent Cryptosporidium antigen test is used versus other diagnostic modalities.
Where specific input data was not provided, the publication notes data limitations. The material is written for a national audience and focuses on clinical utility, billing classification as CPT code 87272, and payer coverage context.
Billing Code Overview
CPT code 87272 describes a laboratory procedure in which a medical laboratory analyst performs an immunofluorescent assay to detect Cryptosporidium antigens. This test identifies the presence of Cryptosporidium organisms in stool or other clinical specimens using fluorescent-labeled antibodies to visualize antigenic material.
Service type: Laboratory diagnostic test — immunofluorescence antigen detection
Typical site of service: Clinical laboratory or hospital laboratory setting, including outpatient lab facilities where stool specimens are processed and analyzed.
Clinical & Coding Specifications
Clinical Context
A symptomatic outpatient presents to a primary care clinic or urgent care with several days of watery diarrhea, abdominal cramping, and mild dehydration after recent travel or a daycare exposure. The clinician collects a stool specimen and orders laboratory testing for enteric pathogens. In the microbiology laboratory, a technologist performs an immunofluorescent assay to detect Cryptosporidium antigens, documented under CPT 87272. Results are reported to the ordering provider; a positive result guides infection control, public health reporting, and targeted therapy or supportive care. Typical sites of service include hospital laboratories, independent clinical laboratories, outpatient clinics with on-site labs, and public health laboratories. The typical patient scenario includes immunocompetent children or adults with acute gastroenteritis, and immunocompromised patients (for example, those with HIV/AIDS or transplant recipients) where identification of Cryptosporidium is clinically important for management and surveillance.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the professional component if separate professional interpretation of the immunofluorescent assay is billed. |
TC | Technical component | Use when billing only the technical component (laboratory testing, equipment, and technician work) for the assay. |
90 | Reference (outside) laboratory | Use when the specimen or testing was performed by an outside reference laboratory and billing reflects that arrangement. |
91 | Repeat clinical diagnostic lab test | Use when the same immunofluorescent test is repeated on the same day for confirmation of results. |
59 | Distinct procedural service | Use when this test is distinct from other services performed on the same day and needs to be indicated as separate. |
52 | Reduced services | Use when the test is partially reduced or not fully performed compared with the full procedure. |
53 | Discontinued procedure | Use when testing was started but discontinued for documented clinical reasons. |
59 | Distinct procedural service | Use when the test represents a distinct service from other accompanying lab tests. |
90 | Reference (outside) lab | Use when sending specimen to an outside lab for the immunofluorescent assay. |
91 | Repeat clinical diagnostic lab test | Use when repeating the assay to confirm unexpected or borderline results. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207Q00000X | Clinical Laboratory | Laboratory directors and clinical laboratory specialists who oversee microbiology testing including immunofluorescent assays. |
| 207L00000X | Pathology | Pathologists who may provide interpretive services for specialized infectious disease testing. |
| 208D00000X | Infectious Disease | Infectious disease specialists who order, interpret, and act on positive Cryptosporidium results. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
A09 | Infectious gastroenteritis and colitis, unspecified | Represents acute diarrheal illness prompting stool testing including for Cryptosporidium. |
A08.4 | Viral intestinal infection, unspecified | Acute enteric infections with similar presentation where multiplex testing including protozoa may be considered. |
A04.7 | Enterocolitis due to Clostridium difficile | Differential diagnosis for severe or persistent diarrhea; labs often order a panel of tests. |
B73.0 | Giardiasis | Another protozoal cause of diarrhea frequently tested alongside Cryptosporidium. |
B58.9 | Toxoplasmosis, unspecified | Included as an opportunistic protozoal infection consideration in immunocompromised patients (less directly related but relevant in the differential). |
B20 | Human immunodeficiency virus [HIV] disease | Immunocompromised patients with HIV are at higher risk for severe cryptosporidiosis and are commonly tested. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
87045 | Culture, bacterial; stool, multiple pathogens, aerobic, initial isolate | May be ordered alongside 87272 to evaluate for bacterial causes of gastroenteritis in the same clinical presentation. |
87328 | Infectious agent antigen detection by enzyme immunoassay, Giardia lamblia | Commonly ordered contemporaneously to evaluate for other protozoal causes of diarrhea when testing for Cryptosporidium. |
87449 | Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; multiplex gastrointestinal pathogen panel | May be performed before or instead of single-agent immunofluorescent testing in comprehensive GI panels. |
87802 | Infectious agent antigen detection by immunoassay technique, qualitative or semiquantitative, multiple pathogens | Used in some labs for rapid antigen testing of enteric pathogens and may be complementary to 87272. |
87476 | Infectious agent detection by nucleic acid (DNA or RNA), individual organism; Cryptosporidium, amplification techniques | Molecular testing for Cryptosporidium that can be ordered alongside or as an alternative to immunofluorescent antigen detection. |