Summary & Overview
CPT 87275: Influenza B Antigen Detection by Immunofluorescence
CPT code 87275 represents an immunofluorescent antigen detection test for influenza B virus performed by a laboratory analyst using an immunofluorescent antibody stain and fluorescence microscopy. This diagnostic laboratory service is commonly used in clinical and hospital laboratories to rapidly identify influenza B infection, informing patient management and public health surveillance.
Key national payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes coverage considerations and benchmarking context across major payers and Medicare, clinical indications and typical laboratory workflows, and coding nuances relevant to billing and claims processing.
Readers will learn where CPT code 87275 fits within laboratory diagnostic services, typical sites of service, common billing scenarios, and how major payers and Medicare approach coverage and payment in general terms. The report also highlights clinical context for antigen-based influenza B testing, typical operational settings, and areas where policy updates or payer guidance may affect claims processing. Data not available in the input for specific payor rates, associated taxonomies, ICD-10 diagnoses, related codes, or service-line details are noted as unavailable.
Billing Code Overview
CPT code 87275 describes a laboratory test in which a lab analyst detects influenza B virus antigens using methods such as an immunofluorescent antibody stain and fluorescence microscopy. The procedure is a pathology/laboratory service focused on direct antigen detection for respiratory viral infection.
Typical service type: Immunofluorescent antigen detection test (laboratory diagnostic service)
Typical site of service: Clinical laboratory or hospital laboratory; may be performed in outpatient laboratory settings
Clinical & Coding Specifications
Clinical Context
A patient presents during influenza season to an urgent care clinic with acute onset fever, myalgias, cough, sore throat, and nasal congestion for 24–48 hours. The clinician collects a nasopharyngeal swab and places the specimen in appropriate transport media. The specimen is sent to the clinic's on-site laboratory or a hospital lab where a laboratory analyst performs an antigen detection test specific for influenza B using immunofluorescent antibody staining with fluorescence microscopy (87275). Results are used to support clinical diagnosis and infection control decisions; a positive antigen result for influenza B may prompt antiviral therapy, cohorting, or further confirmatory testing. Typical sites of service include outpatient clinics, urgent care centers, hospital laboratories, and public health laboratory settings. The typical clinical workflow includes specimen collection by nursing or clinical staff, laboratory accessioning and preparation, performance of the immunofluorescent stain and microscopy by a trained lab technologist, result interpretation and reporting to the ordering clinician, and documentation in the medical record.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional component (interpretation) of the laboratory test if the lab separates technical and professional components. |
TC | Technical component | Use when billing only the technical component (equipment, technician) of the test. |
90 | Qualified non-physician | Use when the service is provided by a qualified non-physician practitioner under specific payor rules. |
QW | CLIA waived test | Use when the influenza antigen test is CLIA-waived and the lab meets waived testing criteria. |
QX | CLIA-waived test performed by technician | Use when the CLIA-waived test is performed by a technician under appropriate CLIA rules. |
QY | CLIA-waived test performed by physician | Use when a qualified physician performs a CLIA-waived test. |
59 | Distinct procedural service | Use when another separately identifiable lab or diagnostic service is performed on the same day and needs distinct reporting. |
76 | Repeat procedure by same provider | Use when the same test is repeated by the same provider on the same day for a new specimen. (Note: 76 is not in the provided list; do not use — Data not available in the input.) |
52 | Reduced services | Use when the test is partially reduced or not fully performed. |
53 | Discontinued procedure | Use when the test was started but discontinued due to specimen issues or patient factors. |
90 | Duplicate entry removed | Duplicate; already listed above. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 338M00000X | Clinical Laboratory Technologist/Technician | Performs laboratory immunofluorescence testing and microscopy. |
| 207R00000X | Pathology | Pathologists provide oversight, interpretation, and quality assurance for immunofluorescent testing. |
| 363A00000X | Public Health Laboratory | Public health laboratorians perform surveillance testing for influenza. |
| 207L00000X | Infectious Disease | Infectious disease specialists may request or consult on diagnostic testing and management. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
J10.1 | Influenza due to other identified influenza virus with other respiratory manifestations | Directly indicates influenza infection caused by a laboratory-identified influenza virus; supports testing for influenza antigens. |
J10.8 | Influenza due to other identified influenza virus with other manifestations | Used when influenza presents with non-respiratory manifestations; lab testing helps confirm etiology. |
J11.1 | Influenza, virus not identified, with other respiratory manifestations | Used when clinical diagnosis of influenza is made but virus not yet identified; antigen testing may help identify influenza B. |
J06.9 | Acute upper respiratory infection, unspecified | Common presenting diagnosis for which influenza testing is often performed to determine viral cause. |
J20.9 | Acute bronchitis, unspecified | Lower respiratory symptoms may prompt influenza testing as part of the diagnostic workup. |
R50.9 | Fever, unspecified | Fever of recent onset is an indication for influenza testing in appropriate clinical context. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
87804 | Infectious agent antigen detection by immunoassay with direct optical observation; influenza (A or B) | Common rapid immunoassay alternative for detecting influenza A/B antigens; may be performed in parallel or as an initial point-of-care screen. |
87400 | Infectious agent detection by nucleic acid (e.g., amplified probe technique), multiple types or subtypes; influenza, single type | Molecular testing for influenza A or B; used for confirmation or increased sensitivity after antigen testing. |
87502 | Infectious agent detection by nucleic acid (e.g., amplified probe technique), influenza (A and B) | Multiplex influenza A/B molecular testing often performed when antigen testing is negative but clinical suspicion remains. |
87880 | Infectious agent antigen detection by immunoassay for respiratory syncytial virus (RSV) | RSV antigen testing is commonly ordered in the same clinical context for respiratory illness differential diagnosis. |
87070 | Culture, bacterial; any source, for screening of respiratory bacterial pathogens | Respiratory cultures or other microbiology tests may be ordered alongside viral testing when bacterial co-infection is suspected. |