Summary & Overview
CPT 87468: Anaplasma phagocytophilum Nucleic Acid Detection
CPT code 87468 represents a nucleic acid amplification test that detects Anaplasma phagocytophilum, the bacterium responsible for anaplasmosis transmitted by tick bites. As a targeted molecular diagnostic, this code is important for confirming acute or suspected anaplasmosis, guiding clinical management, and supporting public health surveillance of tickborne infections nationwide. Payers commonly involved in covering this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn the clinical context for using CPT code 87468, typical sites of service, and how this diagnostic fits into laboratory workflows for tickborne diseases. The publication presents benchmarks and operational considerations relevant to payers and laboratory providers, summarizes common modifiers and billing practice notes when available, and outlines policy and coverage themes that influence access to nucleic acid testing for anaplasmosis. Data not available in the input will be noted as such.
Billing Code Overview
CPT code 87468 describes a molecular diagnostic test that uses an amplified probe technique to detect nucleic acids from the bacterium Anaplasma phagocytophilum, the agent that causes anaplasmosis. This test identifies microbial genetic material to confirm infection after a tick bite or when clinical suspicion for anaplasmosis exists.
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Service type: Infectious disease molecular diagnostic assay (nucleic acid amplification test)
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Typical site of service: Hospital laboratories, independent clinical diagnostic laboratories, and outpatient clinic laboratories where molecular testing is performed.
Clinical & Coding Specifications
Clinical Context
A 52-year-old outdoor worker from the Northeastern United States presents to an urgent care clinic in early summer with 5 days of fever, myalgias, headache, and malaise after a recent tick bite. The clinician documents concern for tick-borne infection and orders molecular testing for Anaplasma phagocytophilum. A blood sample is collected in appropriate transport media and sent to a reference microbiology laboratory capable of performing nucleic acid amplification testing. The laboratory receives the specimen, performs an amplified probe nucleic acid test specific for Anaplasma phagocytophilum, and reports a positive result to the ordering clinician, who documents the result in the medical record and initiates appropriate therapy. Typical site of service: outpatient clinic, urgent care, emergency department, or reference laboratory performing the molecular test. Service type: amplified probe nucleic acid amplification test for Anaplasma phagocytophilum (87468).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation component separate from the technical component for the laboratory result review. |
52 |