Summary & Overview
CPT 87278: Legionella pneumophila Antigen Detection by Immunofluorescence
CPT code 87278 identifies a laboratory antigen detection test for Legionella pneumophila using immunofluorescent antibody stain and fluorescence microscopy. This test is an important diagnostic tool for identifying Legionella infections, which can cause severe pneumonia and public health concerns due to outbreaks. Accurate laboratory identification supports clinical management and infection control efforts nationally.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical purpose and laboratory setting for the service, typical payer coverage considerations, and how the code fits within diagnostic testing practices. The publication covers reimbursement benchmarks where available, coding guidance, and relevant policy updates affecting laboratory billing for antigen detection methods. Clinical context explains when immunofluorescent antigen detection is used versus other Legionella tests, and operational considerations for labs performing fluorescence microscopy.
Data not available in the input for specific associated taxonomies, ICD-10 diagnoses, related codes, or detailed payer-specific coverage rules is noted in the full report.
Billing Code Overview
CPT code 87278 describes a laboratory procedure in which the analyst detects Legionella pneumophila antigens using immunofluorescent antibody staining with evaluation by fluorescence microscopy. The service type is a microbiology/diagnostic laboratory antigen detection test performed to identify Legionella pneumophila infection. The typical site of service is a clinical laboratory or hospital laboratory where trained laboratory personnel conduct immunofluorescent staining and microscopic examination.
Clinical & Coding Specifications
Clinical Context
A 67-year-old man presents to the emergency department with acute onset fever, productive cough, shortness of breath, and pleuritic chest pain after recent hotel stay with reports of a broken cooling tower. Chest radiograph shows a lobar consolidation and the clinician suspects Legionnaires' disease. A respiratory specimen (sputum or bronchoscopic wash) is submitted to the hospital microbiology laboratory. The lab analyst performs an immunofluorescent antibody stain and fluorescence microscopy to detect Legionella pneumophila antigen, documented and billed using 87278. The workflow includes specimen accessioning, fixation and staining with Legionella-specific fluorescent antibodies, microscopic examination, result interpretation and reporting to the ordering provider and infection control. Results guide targeted antibiotic therapy and public health reporting to local health departments when positive.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the professional component (interpretation) of the test is billed by a physician or laboratorian and the technical component is billed separately. |
TC |