Summary & Overview
CPT 87273: HSV-2 Antigen Detection by Immunofluorescence
CPT code 87273 represents an immunofluorescent laboratory test to detect antigens of Herpes simplex virus type 2 (HSV-2), the virus commonly responsible for genital herpes. This test is a targeted diagnostic procedure used in clinical and hospital laboratories to identify viral proteins in patient specimens and support acute or suspected HSV-2 infection evaluation. Nationally, accurate laboratory identification of HSV-2 informs patient management, infection control, and public health surveillance.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for CPT code 87273, typical sites of service, and the kinds of benchmarks and payer coverage considerations commonly examined for laboratory virology codes. The publication also summarizes relevant billing modifiers and common administrative details where available.
The report is organized to provide: a clinical description and service use case; payer coverage scope and typical reimbursement considerations; and operational context for laboratories that perform immunofluorescent antigen detection for HSV-2. Data not available in the input is identified where applicable.
Billing Code Overview
CPT code 87273 describes a laboratory test in which a lab analyst detects antigens to Herpes simplex virus type 2 (HSV-2, genital herpes) using an immunofluorescent technique. The service is a diagnostic virology antigen detection procedure that identifies viral proteins in clinical specimens to support diagnosis of HSV-2 infection.
Service type: Laboratory diagnostic test — immunofluorescence antigen detection
Typical site of service: Clinical laboratory or hospital laboratory setting, including outpatient lab draw sites where specimens are processed and analyzed.
Clinical & Coding Specifications
Clinical Context
A 28-year-old sexually active female presents to a clinic with painful genital vesicular lesions and regional lymphadenopathy. A clinician in family medicine or sexual health obtains a swab of an active lesion and sends the specimen to the laboratory for direct immunofluorescent testing for Herpes simplex virus type 2. In the lab, a cytotechnologist or medical technologist prepares the specimen, applies fluorescent-labeled antibodies specific to HSV-2 antigens, and examines slides under a fluorescence microscope to detect viral antigen. Results are reported to the ordering provider for clinical management, which may include antiviral therapy and partner counseling. Typical site of service is an outpatient clinic, sexual health clinic, urgent care center, or hospital outpatient laboratory where immunofluorescent testing is available.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the professional interpretation portion if the lab sends slides to a pathologist for interpretation separate from the technical work |
TC | Technical component | When billing only the technical component (laboratory processing and staining) without the professional interpretation |
90 | Reference (outside) laboratory | When the test is performed by an outside/reference laboratory and the billing provider is reporting that external service |
91 | Repeat clinical diagnostic test | Not in provided list; omitted to adhere to input modifiers |
59 | Distinct procedural service | Not in provided list; omitted to adhere to input modifiers |
90 | Duplicate entry avoided | Duplicate modifiers must not be repeated |
52 | Reduced services | When the test is partially performed or limited relative to the full procedure |
53 | Discontinued procedure | When testing was begun but discontinued due to specimen unsuitability or other reason |
78 | Unplanned return to OR by same physician | Generally not applicable to this lab test; included modifiers limited to clinically relevant ones |
80 | Assistant surgeon | Not applicable to this procedure |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207Q00000X | Family Medicine | Frequently orders and collects lesion swabs for HSV testing |
| 207R00000X | Internal Medicine | May evaluate and order testing for adult patients with genital lesions |
| 208D00000X | Obstetrics & Gynecology | Commonly evaluates female patients with genital lesions and orders HSV testing |
| 208000000X | Emergency Medicine | Orders rapid diagnostic testing for acute presentations in urgent care or ED settings |
| 394A00000X | Pathology & Clinical Laboratory | Performs immunofluorescent testing and interprets results |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
A60.0 | Anogenital herpesviral [herpes simplex] infection due to herpes simplex virus type 1 | Differentiates HSV-1 anogenital infections; HSV-2 testing helps distinguish etiology |
A60.1 | Anogenital herpesviral [herpes simplex] infection due to herpes simplex virus type 2 | Directly indicates HSV-2 disease; primary indication for 87273 testing |
B00.53 | Disseminated herpes simplex with other complications | Severe or disseminated disease where typing and antigen detection may be part of the workup |
B00.9 | Herpesviral infection, unspecified | When the clinician documents herpes infection without specifying type; testing clarifies HSV-2 presence |
R22.39 | Localized swelling, mass and lump, other sites | Used when regional swelling/lymphadenopathy accompanies genital lesions prompting diagnostic testing |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
87273 | Infectious agent antigen detection by immunofluorescent technique, each specimen; herpes simplex virus type 2 | Primary procedure: direct immunofluorescent detection of HSV-2 antigen from lesion specimen |
87252 | Infectious agent antigen detection by enzyme immunoassay; herpes simplex virus type 1 and 2, single, each | Alternative antigen detection method that may be performed instead of or in addition to immunofluorescence |
87529 | Infectious agent detection by nucleic acid (DNA or RNA), herpes simplex virus, amplified probe technique, multiplex; single organism | Molecular testing performed when higher sensitivity or typing by PCR is required, often used after or instead of antigen testing |
87077 | Culture, pathogenic organism, screening for viruses (e.g., herpes simplex) | Viral culture may be ordered when culture capability exists; complements antigen or molecular testing |
87621 | Infectious agent detection by nucleic acid (DNA or RNA), herpes simplex virus types 1 and 2, amplified probe technique; multiplex | Multiplex PCR for simultaneous HSV-1 and HSV-2 detection; often used in contemporary workflows alongside or replacing immunofluorescent testing |