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. |