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CPT 87481: Detection of Candida Species by Amplified Nucleic Acid Probe
CPT code 87481 represents a molecular diagnostic assay for detection of Candida species using an amplified nucleic acid probe. This laboratory test supports identification of fungal pathogens that may cause mucosal or invasive infections and informs clinical management and infection control decisions. Nationally, accurate molecular testing for Candida is increasingly important for timely diagnosis and appropriate treatment selection.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication reviews coverage and billing considerations relevant to these payers, benchmarks for utilization where available, and the clinical context in which the test is typically ordered.
Readers will find a concise explanation of the code and its clinical purpose, an overview of common sites of service and service type, and a summary of associated billing elements and related codes. The piece also outlines typical diagnostic indications and how the test fits into laboratory workflows. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 87481 describes a laboratory test in which a lab analyst performs detection of Candida species using an amplified nucleic acid probe technique. The service is a molecular diagnostic assay designed to identify Candida organisms from clinical specimens.
Service Type: Laboratory — molecular diagnostic testing
Typical Site of Service: Clinical laboratory or outpatient laboratory setting
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.