Summary & Overview
CPT 87280: RSV Antigen Detection by Immunofluorescent Stain
CPT code 87280 denotes an in-lab antigen detection test for respiratory syncytial virus (RSV) using immunofluorescent antibody staining and fluorescence microscopy. This molecular/virology diagnostic procedure is clinically important for identifying RSV infections, which are a leading cause of respiratory illness in infants, young children, older adults, and immunocompromised patients. Accurate and timely RSV detection supports patient management decisions and infection control in healthcare settings.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national overview of clinical context for CPT code 87280, how it fits into laboratory service lines, and typical sites of service. The publication provides benchmarks where available, notes on billing practice considerations, and summaries of recent policy updates that affect laboratory testing and reimbursement for antigen-based RSV diagnostics.
The piece is intended for laboratory managers, billing professionals, and healthcare policy analysts seeking concise guidance on coding context, payer coverage landscape, and operational implications for RSV antigen testing using immunofluorescence. Data not available in the input will be noted where relevant.
Billing Code Overview
CPT code 87280 describes a laboratory test performed by a lab analyst to detect respiratory syncytial virus (RSV) antigens using methods such as an immunofluorescent antibody stain with fluorescence microscopy.
Service Type: Diagnostic virology / antigen detection test
Typical Site of Service: Clinical laboratory or hospital laboratory; may be performed in outpatient or inpatient laboratory settings
Clinical & Coding Specifications
Clinical Context
A typical patient is an infant or young child presenting to an outpatient clinic, urgent care, emergency department, or pediatric hospital unit during RSV season with symptoms of bronchiolitis or lower respiratory tract infection such as cough, tachypnea, wheezing, nasal flaring, poor feeding, or hypoxia. A clinician collects a nasopharyngeal swab or aspirate and sends the specimen to the hospital or reference laboratory. A laboratory technologist or medical technologist performs an immunofluorescent antibody stain and evaluates the specimen by fluorescence microscopy to detect respiratory syncytial virus antigen, documented as CPT 87280. Results are reported to the ordering provider and entered into the electronic health record to inform infection control, antiviral decisions, and supportive management. Typical sites of service include outpatient clinics, urgent care centers, hospital laboratories, and public health laboratories. Common workflow steps: clinician collects specimen → specimen labeled and transported to lab → lab accessioning and processing → immunofluorescent staining and fluorescence microscopy interpretation → result reporting and coding for billing as CPT 87280.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation component by the physician or qualified laboratory medical director separate from technical component. |