CPT 87478: Molecular Detection of Borrelia miyamotoi - OpenPayer

Summary & Overview

CPT 87478: Molecular Detection of Borrelia miyamotoi

CPT code 87478 designates a molecular diagnostic assay using amplified probe technology to detect nucleic acids from Borrelia miyamotoi, the bacterium linked to tickborne relapsing fever (TBRF). Nationally, this code captures specialized infectious disease testing that supports diagnosis of a less common tickborne pathogen with growing clinical recognition. The code matters for laboratories, clinicians evaluating febrile or relapsing illness after tick exposure, and payers managing coverage and appropriate use of molecular infectious disease panels.

Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and typical laboratory site of service, plus what to expect in payer coverage discussions and benchmarking. The publication also summarizes common billing modifiers and identifies where data was not provided.

This resource provides: clinical purpose and testing method; expected site-of-service and operational implications for laboratories; guidance on common modifiers used with molecular pathology billing; and notes on missing input elements where applicable. The content is written for a national audience of laboratory directors, coding and billing specialists, clinicians, and payer policy analysts.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 87478molecular diagnosticBorrelia miyamotoitickborne relapsing feverinfectious disease testingclinical laboratoryamplified probelaboratory billingdiagnostic code

Billing Code Overview

CPT code 87478 describes a molecular diagnostic test that uses an amplified probe technique to detect nucleic acids from the bacterium Borrelia miyamotoi, an agent associated with tickborne relapsing fever (TBRF). The assay identifies pathogen-specific genetic material to support diagnosis of infection caused by this tick-transmitted organism.

Service Type: Molecular diagnostic infectious disease testing

Typical Site of Service: Clinical laboratory or hospital laboratory settings where molecular testing is performed, including reference laboratories. Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 42-year-old outdoor worker presents to an outpatient infectious disease clinic in late spring with fever, recurrent episodes of chills and sweats, headache, and myalgias. The clinician documents a history of multiple recent tick bites and local erythema. Initial physical exam and basic labs are non-specific; the clinician suspects a tickborne relapsing fever–type illness and orders molecular testing for Borrelia miyamotoi. A venous blood sample is collected and sent to a reference laboratory that performs nucleic acid amplification testing using an amplified probe technique. Results are reported to the ordering clinician electronically; positive detection confirms the presence of Borrelia miyamotoi nucleic acid and supports targeted antimicrobial therapy and public health reporting as indicated.

Typical workflow:

Patient evaluation in clinic with history and exam.
Specimen collection (venous blood) using standard phlebotomy techniques.
Specimen packaged and shipped to a laboratory capable of performing amplified probe nucleic acid testing for Borrelia miyamotoi.
Laboratory performs 87478 testing and documents results in the laboratory information system; if performed in two components, the technical component and any professional interpretation are documented.
Results communicated to ordering clinician; relevant ICD-10 diagnosis documented in the medical record to support medical necessity and billing.

Coding Specifications

Related Codes

87428

CPT 87428: Antigen Detection for COVID-19 and Influenza A/B

cpt-87624-high-risk-hpv-nucleic-acid-detection-pooled

CPT 87624: High-Risk HPV Nucleic Acid Detection, Pooled Result

cpt-87273-hsv-2-antigen-immunofluorescence

CPT 87273: HSV-2 Antigen Detection by Immunofluorescence

cpt-87265-bordetella-immunofluorescent-antigen-detection

CPT 87265: Immunofluorescent Antigen Detection for Bordetella

cpt-87468-anaplasma-phagocytophilum-nucleic-acid-detection

CPT 87468: Anaplasma phagocytophilum Nucleic Acid Detection

cpt-87580-mycoplasma-pneumonia-nucleic-acid-probe

CPT 87580: Mycoplasma pneumoniae Direct Nucleic Acid Probe Test

cpt-87510-gardnerella-vaginalis-nucleic-acid-probe

CPT 87510: Gardnerella vaginalis Nucleic Acid Probe Test

cpt-87653-group-b-streptococcus-naat

CPT 87653: Streptococcus Group B Detection by Amplified Probe

cpt-87475-borrelia-burgdorferi-direct-nucleic-acid-probe-test

CPT 87475: Borrelia burgdorferi Direct Nucleic Acid Probe Test

cpt-87290-varicella-zoster-virus-antigen-detection-immunofluorescence

CPT 87290: Varicella Zoster Virus Antigen Detection by Immunofluorescence

Showing 1–10 of 167

Taxonomy Code	Specialty	Notes
`207R00000X`	Infectious Disease	Specialists ordering and interpreting complex tickborne disease testing.
`207L00000X`	Pathology & Laboratory Medicine	Laboratory directors and pathologists overseeing molecular diagnostics.
`208D00000X`	Family Medicine	Primary care clinicians who evaluate patients with tick exposure and order testing.
`208000000X`	Internal Medicine	Internists who diagnose and manage tickborne infections.
`223Z00000X`	Emergency Medicine	Emergency clinicians who may order acute testing for febrile patients with tick exposure.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`A69.2`	Other specified spirochetal infections	Used for documented spirochetal infections when Borrelia miyamotoi infection is suspected or confirmed.
`A77.1`	Spotted fever due to Rickettsia rickettsii	Included as a related tickborne differential diagnosis that may be considered and tested for in the same clinical encounter.
`A92.3`	Tick-borne viral encephalitis	Represents another tick-associated infectious disease in the differential for neurologic symptoms.
`T63.004A`	Toxic effect of contact with venom of other arthropods, initial encounter	May be used for acute reactions to tick bites where exposure is documented; not specific for infection but relevant to encounter coding.
`Z20.828`	Contact with and suspected exposure to other viral communicable diseases	Used when there is documented exposure risk (tick bites) and testing for a transmissible agent is ordered.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`36415`	Collection of venous blood by venipuncture	Often performed immediately before `87478` to obtain the specimen for molecular testing.
`87070`	Culture, bacterial, any source, a presumptive, single culture	May be ordered concurrently to evaluate for other bacterial bloodstream pathogens if sepsis is a concern.
`87471`	Infectious agent detection by nucleic acid (DNA or RNA); Borrelia burgdorferi, amplified probe technique	Performed when Lyme disease (Borrelia burgdorferi) is in the differential and molecular testing for alternate Borrelia species is needed.
`86788`	Antibody; Borrelia burgdorferi (Lyme)	Serologic testing that may be ordered alongside molecular testing to assess immune response or prior exposure.
`99000`	Handling and/or conveyance of specimens for transfer from patient to lab when appropriate (example)	Administrative or specimen-handling codes sometimes billed by facilities when required by payer rules.

`26`	Professional component	Use when only the physician interpretation or professional component is billed separate from the lab's technical component.
`TC`	Technical component	Use when billing only the laboratory technical component (equipment, reagents, personnel) for the test.
`59`	Distinct procedural service	Use when another diagnostic test or service on the same day is unrelated and distinct from `87478`.
`91`	Repeat clinical diagnostic laboratory test	Use when the same molecular test is repeated on a subsequent specimen to confirm results.
`90`	Reference (outside) laboratory	Use when the test is performed by an outside reference laboratory and billing must indicate reference lab involvement.
`90` is CMS-recognized; some payors prefer `90` alongside `TC`/`26`.	When specimens are sent to an independent outside lab for performance of `87478`.
`52`	Reduced services	Use when the test is partially performed or limited relative to the full CPT description.
`53`	Discontinued procedure	Use if specimen collection or testing was started but discontinued for clinical reasons before completion.
`22`	Unusual procedural services	Use when work or resources required to perform the test substantially exceed the typical service (rare for standard assays).
`59`	Distinct procedural service	Use to indicate a separate, distinct service when multiple lab procedures are performed same day (listed above).