Summary & Overview
CPT 87276: Influenza A Immunofluorescent Antigen Detection
CPT code 87276 denotes an immunofluorescent antibody staining assay with fluorescence microscopy to detect influenza A virus antigens. This laboratory-based diagnostic procedure is clinically important for timely identification of influenza A, informing infection control and clinical decision-making across inpatient and outpatient settings. Nationally, accurate coding of such tests influences surveillance, reporting, and reimbursement for laboratory services.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for antigen-based influenza testing, payer coverage patterns, and where CPT 87276 fits among laboratory diagnostic services. The publication outlines typical sites of service and operational considerations for laboratories offering immunofluorescent antigen detection.
The report provides benchmarks and policy context relevant to CPT code 87276, including common billing practices and coding considerations for labs and billing teams. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 87276 describes a laboratory test in which a clinical laboratory analyst detects influenza A virus antigens using immunofluorescent antibody staining and fluorescence microscopy. This assay is a type of infectious disease antigen detection performed by trained laboratory personnel to identify viral proteins from respiratory specimens.
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Service type: Laboratory diagnostic test (immunofluorescent antigen detection)
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Typical site of service: Hospital clinical laboratory, specialized reference laboratory, or outpatient laboratory facility where microscopy and fluorescence immunostaining are performed.
Clinical & Coding Specifications
Clinical Context
A 6-year-old child presents to an urgent care clinic in winter with acute onset fever, cough, nasal congestion, myalgia, and lethargy for 24 hours. A clinician performs a focused respiratory exam and obtains a nasopharyngeal swab. The specimen is sent to the on-site laboratory where a medical laboratory scientist prepares a slide and performs an immunofluorescent antibody stain to detect influenza A viral antigens. The lab analyst examines the slide under fluorescence microscopy and documents positive or negative antigen staining, reporting results to the ordering clinician to guide antiviral therapy decisions and infection control precautions. Typical workflow steps: specimen collection, accessioning, reagent preparation, immunofluorescent staining, fluorescence microscopy interpretation, result verification, and electronic reporting to the clinician and the medical record. Typical site of service: hospital laboratory, hospital outpatient laboratory, or an urgent care/clinic laboratory performing in-house rapid immunofluorescence testing. Service type: laboratory diagnostic immunofluorescent antigen detection.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the physician or laboratorian interpretation/reading of the fluorescence microscopy separate from technical services |
TC | Technical component | When billing only the technical aspects (reagents, equipment, technologist time) of the test |
90 | Reference (outside) laboratory | When the specimen is sent to an outside reference laboratory for testing |
52 | Reduced services | When the test is partially performed or limited compared with the service definition |
59 | Distinct procedural service | When another separate and distinct service is performed on the same day that is not bundled with the antigen test |
76 | Repeat procedure by same provider | When the same test is repeated later by the same provider for the same patient |
77 | Repeat procedure by another provider | When the same test is repeated by a different provider/lab |
90 | Modifier 90 is listed above; duplicate entries are not included | Data not applicable |
91 | Repeat clinical diagnostic laboratory test | When the test is repeated on the same specimen to verify results (note: use only if applicable per payer rules) |
59 | Modifier 59 is listed above; duplicate entries are not included | Data not applicable |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 1223P0001X | Pathology & Laboratory Medicine | Medical directors and pathologists overseeing lab testing and result interpretation |
| 363L00000X | Clinical Laboratory | Medical laboratory scientists and clinical laboratory personnel performing staining and microscopy |
| 207Q00000X | Family Medicine | Clinicians who order the test in urgent care, outpatient clinics |
| 207R00000X | Internal Medicine | Hospitalists and internists ordering testing for inpatient/ED patients |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
J10.1 | Influenza due to other identified influenza virus with other respiratory manifestations | Direct indication for influenza antigen testing when influenza virus is suspected and identified |
J11.1 | Influenza, virus not identified, with other respiratory manifestations | Used when influenza is suspected clinically and testing is performed but virus may not be identified by rapid methods |
J06.9 | Acute upper respiratory infection, unspecified | Common presenting diagnosis that prompts respiratory viral testing including influenza antigen assays |
J20.9 | Acute bronchitis, unspecified | Respiratory symptoms where influenza testing may be clinically appropriate during influenza season |
R50.9 | Fever, unspecified | Fever without localizing signs that often triggers evaluation for influenza infection with antigen testing |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
87631 | Infectious agent antigen detection by immunoassay, influenza virus, A or B, multiple types or subtypes; rapid single-step assay | Common alternative rapid antigen test that may be used instead of or alongside immunofluorescent assays for influenza detection |
87400 | Infectious agent antigen detection by immunoassay for respiratory syncytial virus (RSV) | Often performed on the same respiratory specimen when evaluating viral respiratory illness in young children |
87804 | Infectious agent antigen detection by immunofluorescent technique, respiratory pathogens, multiple organisms | Related immunofluorescent methods that may be used when a panel of respiratory viruses is tested by the lab |
87070 | Culture, bacterial; diagnostic, any source, with isolation and presumptive identification of isolates | Performed when secondary bacterial infection is suspected or culture is indicated after antigen testing |
99000 | Handling and/or conveyance of specimen to another lab (historical code) | Administrative/specimen transfer activities when specimens are forwarded to reference laboratories (use payer-specific codes/procedures for specimen transport) |