Summary & Overview
CPT 87427: Enzyme Immunoassay for Shiga-like Toxin Detection
CPT code 87427 represents an enzyme immunoassay (EIA) laboratory test for detection of Shiga-like toxins produced by pathogens such as Shigella dysenteriae type 1 and verotoxin-producing E. coli (VTEC), including E. coli O157. This molecular immunoassay is clinically important for diagnosing toxin-mediated diarrheal illness and identifying patients at risk for severe complications such as hemolytic uremic syndrome. Nationally, accurate and timely toxin detection informs patient management, infection control, and public health surveillance.
Key payers covered 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 toxin testing, how this service is billed under CPT code 87427, and the common payer landscape relevant to reimbursement and coverage. The publication outlines benchmarks and billing practice considerations, summarizes applicable modifiers and service line information where available, and highlights the typical laboratory setting and use cases for the assay.
The content is designed for clinicians, laboratory managers, and billing professionals seeking a national perspective on coding and clinical application for EIA-based Shiga-like toxin testing under CPT code 87427.
Billing Code Overview
CPT code 87427 describes a laboratory assay using an enzyme immunoassay (EIA) technique to detect Shiga-like toxins produced by organisms such as Shigella dysenteriae type 1 and verotoxin-producing Escherichia coli (VTEC), including E. coli O157. The service is a microbiology diagnostic test performed by a clinical laboratory analyst to identify bacterial toxin presence in patient specimens.
Service type: Laboratory — infectious disease toxin detection
Typical site of service: Clinical laboratory or hospital laboratory
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or pediatric patient presenting to an urgent care clinic or emergency department with acute onset of bloody diarrhea, severe abdominal cramping, fever, or a history of recent travel or a suspected foodborne outbreak. The clinician collects a stool specimen and orders a laboratory diagnostic panel for enteric pathogens; the laboratory performs 87427 using an enzyme immunoassay (EIA) to detect shiga-like toxins (Shiga toxin 1 and 2) produced by organisms such as Shigella dysenteriae type 1 or Shiga toxin–producing Escherichia coli (e.g., E. coli O157:H7). The workflow includes specimen receipt, accessioning, performing the EIA per manufacturer instructions, running appropriate controls, reporting positive or negative toxin results to the ordering clinician, and reflexing to culture or molecular confirmation (if local protocol requires) for public health reporting. Results inform clinical management (e.g., fluid resuscitation, avoidance of antibiotics when contraindicated for EHEC), infection control precautions, and notification to public health authorities in outbreak situations.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation component if the laboratory separates technical and professional components and the physician bills for interpretation. |