CPT 87481: Candida Species Detection by Amplified Nucleic Acid Probe
Commercial payers pay $72 on average nationally for this procedure.
CPT code 87481 describes a laboratory test in which a lab analyst uses an amplified nucleic acid probe technique to detect Candida species, representing a molecular diagnostic service typically processed in a clinical laboratory or hospital laboratory setting for evaluation of suspected fungal infection in genitourinary or other clinical specimens.
For related coverage guidance, see recent payer policy updates: B-Hemolytic Streptococcus Testing, Human Immunodeficiency Virus (HIV) — Coverage Criteria for Testing and Resistance Assays, Hepatitis Testing (A, B, C, D) Coverage Criteria.
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National Reimbursement Benchmarks
Commercial reimbursement for CPT 87481 centers around BUCA as an average-commercial benchmark at $72.20, with variation among national payers. Blue Cross Blue Shield shows the highest central tendency (median $93.60, mean $100.60) while Aetna and UnitedHealth Group sit lower (medians $28.10 and $21.10, means $32.90 and $30.10 respectively). Cigna’s median is $33.70 with a mean of $39.60. These differences highlight a broad cross-payer spread in typical payments for the code.
Examining dispersion (P75 minus P25) highlights relative consistency versus volatility: Blue Cross Blue Shield’s interquartile range is $45.80, the widest, indicating the largest middle-50% variability. BUCA’s IQR is $34.00, while Cigna’s IQR is $28.20. Aetna’s IQR is $15.60 and UnitedHealth Group is the tightest at $19.70, signaling more concentrated reimbursement levels for that payer.