Summary & Overview
CPT 87274: HSV-1 Antigen Detection by Immunofluorescence
CPT code 87274 covers laboratory detection of Herpes simplex virus type 1 (HSV-1) antigens using immunofluorescent antibody staining and fluorescence microscopy. This test is used in clinical microbiology laboratories to identify HSV-1 infection directly from patient specimens and can affect diagnosis, infection control, and antiviral treatment decisions. Nationally, antigen detection methods remain part of the diagnostic toolkit alongside viral culture and molecular assays, with use varying by clinical setting and laboratory capability.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for antigen-based HSV-1 testing, typical sites of service, and how CPT code 87274 fits into laboratory service lines. The publication summarizes common billing modifiers and payer coverage patterns where available, highlights benchmarking and reimbursement considerations, and provides policy and coding guidance relevant to laboratories and billing professionals. Data not available in the input is noted where applicable. This piece is intended for laboratory managers, billing specialists, and policy analysts seeking a national-level briefing on CPT code 87274 and its clinical billing context.
Billing Code Overview
CPT code 87274 describes a laboratory test performed by a clinical laboratory analyst to detect Herpes simplex virus type 1 (HSV-1) antigens using methods such as an immunofluorescent antibody stain and fluorescence microscopy.
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Service type: Laboratory infectious disease antigen detection using immunofluorescence
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Typical site of service: Clinical laboratory or hospital laboratory where specimen processing and fluorescence microscopy are performed
Clinical & Coding Specifications
Clinical Context
A 28-year-old adult presents to an urgent care clinic with a 3-day history of a painful grouped vesicular rash on the labial mucosa and perioral skin. The clinician performs a focused history and physical exam, collects a specimen using a swab or scraping from an intact vesicle or mucosal lesion, and sends the specimen to the on-site or reference laboratory for direct antigen detection of Herpes simplex virus type 1 using an immunofluorescent antibody (IFA) stain with fluorescence microscopy. The lab analyst receives the specimen, processes it for IFA staining, incubates with fluorescent-labeled HSV-1–specific antibodies, and reads slides by fluorescence microscopy to detect viral antigen. Results (positive, negative, or indeterminate) are reported back to the ordering clinician and documented in the medical record to guide antiviral therapy decisions and infection control counseling.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional component (interpretation) of the test if the lab analytic and professional reporting components are separated. |
TC | Technical component | Use when billing only the technical component (laboratory processing and microscopy) and another entity bills the professional interpretation. |
90 | Reference (outside) laboratory | Use when the test specimen is sent to an independent reference laboratory for analysis. |
59 | Distinct procedural service | Use when this test is performed on a different lesion or at a distinct encounter from other services to indicate a separate service. |
52 | Reduced services | Use when the laboratory performed a reduced or partial version of the procedure. |
53 | Discontinued procedure | Use when testing was started but discontinued for patient-related or specimen issues. |
76 | Repeat procedure by same physician or facility | Use when the same lab repeats the test during the same encounter for verification. |
77 | Repeat procedure by another physician or facility | Use when a different lab repeats the test on the same day or encounter. |
90 | Reference (duplicate included above as CMS standard) | See above. |
59 | Distinct procedural service (duplicate noted) | See above. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207RX0200X | Pathology & Laboratory Medicine | Medical directors and laboratory pathologists overseeing virology testing. |
| 208100000X | Diagnostic Radiology (Laboratory Tech placeholder) | Clinical laboratory technicians and medical technologists performing staining and microscopy. |
| 207L00000X | Anatomic Pathology | Specialists who may interpret immunofluorescent studies in some settings. |
| 2080P0200X | Clinical Laboratory | Phlebotomists and lab personnel involved in specimen handling and processing. |
| 2083L0002X | Microbiology | Microbiologists specializing in viral antigen detection and virology workflows. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
B00.0 | Eczema herpeticum | HSV infection presenting with widespread vesicular eruption; IFA can aid rapid antigen detection. |
B00.1 | Herpesviral vesicular dermatitis | Localized HSV vesicular lesions; direct antigen testing from lesion is clinically relevant. |
B00.2 | Herpesviral gingivostomatitis and pharyngotonsillitis | Orolabial HSV presentations where lesion swabs are tested for HSV-1 antigen. |
B00.3 | Herpesviral meningitis | Not typically diagnosed by lesion antigen testing but HSV identification may guide broader workup; molecular testing is preferred for CNS involvement. |
B00.4 | Herpesviral encephalitis | CNS HSV disease requires nucleic acid testing of CSF rather than antigen IFA of lesions; listed for clinical context. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
87274 | Infectious agent antigen detection by immunofluorescent stain, herpes simplex virus (HSV), direct; laboratory analyst performing the test and reading by fluorescence microscopy | Primary procedure: direct antigen detection of HSV-1 from lesion specimens. |
87252 | Infectious agent antigen detection by enzyme immunoassay technique (e.g., enzyme-linked immunosorbent assay, ELISA), herpes simplex virus | Alternative laboratory method for HSV antigen detection when IFA is not used; may be performed instead of or in addition to IFA. |
87270 | Infectious agent antigen detection by immunofluorescent stain, respiratory syncytial virus (RSV) | Example of another immunofluorescent antigen detection test using similar lab techniques and workflows. |
87471 | Infectious agent detection by nucleic acid (DNA or RNA); herpes simplex virus, amplified probe technique, direct probe technique | Molecular testing alternative or follow-up for greater sensitivity or typing, often performed if antigen testing is negative but clinical suspicion persists. |
87490 | Infectious agent detection by nucleic acid; herpes simplex virus types 1 and 2, amplified probe technique, each type | Typing and higher-sensitivity testing used in complex or recurrent cases or for specimen confirmation. |