Summary & Overview
CPT 87485: Chlamydia pneumoniae Direct Nucleic Acid Probe Test
CPT code 87485 represents a molecular diagnostic assay using a direct nucleic acid probe to detect Chlamydia pneumoniae, an agent of respiratory infections that ranges from mild illness in children to more severe disease in adults. This code is used by clinical and hospital laboratories to report the testing procedure when direct probe techniques are employed. Nationally, accurate reporting of such pathogen-specific molecular tests supports surveillance, appropriate clinical management, and lab payment consistency.
Key payers covered in this discussion include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code denotes, the typical laboratory and clinical context in which it is used, and the expected sites of service. The publication also describes benchmarks and policy-relevant topics readers can expect, including billing and coding considerations for molecular infectious disease testing, payer coverage patterns, and clinical implications of identifying Chlamydia pneumoniae in respiratory specimens.
Data not available in the input for payer-specific rates, claim volumes, associated taxonomies, and ICD-10 diagnoses. The report focuses on clinical context, coding definition, and national relevance of CPT code 87485.
Billing Code Overview
CPT code 87485 describes a laboratory test in which a lab analyst performs a direct nucleic acid probe technique to detect Chlamydia pneumoniae (also known as TWAR or Taiwan Acute Respiratory agent). The procedure identifies the organism’s nucleic acid directly from respiratory specimens.
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Service type: Diagnostic molecular test using direct nucleic acid probe technique
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Typical site of service: Clinical laboratory or hospital laboratory performing respiratory infectious disease testing
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Clinical & Coding Specifications
Clinical Context
A 45-year-old adult presents to an outpatient primary care clinic with a 10-day history of persistent cough, low-grade fever, and increasing shortness of breath. The clinician documents suspected atypical community-acquired pneumonia and orders laboratory testing to evaluate for respiratory pathogens, including Chlamydia pneumoniae. A nasal or nasopharyngeal swab or lower respiratory specimen is collected by the clinic or an associated collection site and sent to the affiliated clinical laboratory. The laboratory analyst performs a direct nucleic acid probe assay to detect Chlamydia pneumoniae genomic material, resulting in a qualitative positive or negative report returned to the ordering clinician. Typical sites of service include outpatient clinics, hospital outpatient departments, urgent care centers, and reference laboratories. The workflow includes specimen collection, accessioning, nucleic acid probe testing by trained lab personnel, quality controls, result verification, and electronic reporting to the provider for clinical management.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the professional component of a split-service laboratory test if applicable in limited reporting scenarios. |
TC |