Summary & Overview
CPT 87425: Rotavirus Antigen Detection by Immunoassay
CPT code 87425 denotes an immunoassay-based laboratory test for detection of rotavirus antigen. This code is used to report diagnostic virology testing when a laboratory employs an antigen detection method such as an enzyme immunoassay (EIA). Accurate coding for rotavirus antigen testing matters nationally because it supports infectious disease surveillance, appropriate patient management, and accurate laboratory reimbursement across outpatient and inpatient settings.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the test, typical sites of service, and the common modifiers associated with laboratory billing. The publication provides benchmarks and coding practice guidance for claim preparation, highlights payer coverage patterns where available, and summarizes relevant billing considerations for laboratories and billing professionals.
The brief explains when CPT code 87425 is applicable, practical implications for lab billing workflows, and where to expect variation in payer adjudication and documentation requirements. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 87425 describes a laboratory test in which a lab analyst detects rotavirus antigens using an immunoassay technique (for example, enzyme immunoassay).
-
Service type: Diagnostic virology laboratory test
-
Typical site of service: Clinical laboratory or hospital laboratory; testing may be performed on specimens collected in outpatient clinics or inpatient settings depending on clinical workflow.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 9-month-old infant presents to the pediatric urgent care clinic with a 48-hour history of watery, non-bloody diarrhea, frequent vomiting, low-grade fever, and signs of mild dehydration (decreased urine output, dry mucous membranes). The clinician obtains a focused history and performs a brief exam, documents vital signs and hydration status, and collects a stool specimen at the point-of-care or sends it to the outpatient laboratory. The laboratory performs an immunoassay (e.g., enzyme immunoassay, EIA) to detect rotavirus antigen. Results are used to confirm viral gastroenteritis, guide isolation precautions, and inform supportive management (oral rehydration, electrolyte management). Typical sites of service include outpatient clinics, pediatric urgent care centers, emergency departments, and hospital laboratories where stool antigen immunoassays are performed. The testing is usually ordered when viral etiology is suspected and rapid antigen detection will affect infection control and cohorting decisions, especially in pediatric or neonatal settings.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the professional component of the laboratory interpretation is billed by a physician or other qualified provider distinct from the performing laboratory. |
59 |