Summary & Overview
CPT 87486: Chlamydia pneumoniae Nucleic Acid Probe Test
CPT code 87486 denotes an amplified nucleic acid probe test for Chlamydia pneumoniae, a respiratory pathogen that can cause mild illness in children and more severe respiratory disease in adults. This molecular diagnostic code is nationally significant because it supports targeted clinical management of respiratory infections and informs infection control and epidemiologic surveillance.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for testing, typical sites of service, and the service type. The publication outlines commonly reported payer considerations and common billing modifiers associated with laboratory services. It also provides benchmarking context and policy-relevant notes to help billing and laboratory operations teams understand reimbursement landscapes and coding practice implications.
The report equips laboratory directors, billing specialists, and clinical leaders with clear information on what CPT code 87486 represents, why the test is used clinically, and the administrative aspects relevant at a national level. Data not available in the input is identified where applicable.
Billing Code Overview
CPT code 87486 describes a laboratory test that detects Chlamydia pneumoniae using an amplified nucleic acid probe technique. The procedure targets the respiratory pathogen also known as TWAR (Taiwan Acute Respiratory agent) and is used to identify infection by this organism.
Service type: Infectious disease molecular diagnostic test
Typical site of service: Clinical laboratory or hospital laboratory, performed on respiratory specimens
Clinical & Coding Specifications
Clinical Context
A 45-year-old adult presents to an outpatient primary care clinic with a 10-day history of persistent nonproductive cough, low-grade fever, and malaise. The clinician documents suspected atypical community-acquired pneumonia and orders laboratory testing to detect respiratory pathogens. A nasopharyngeal swab or lower respiratory specimen is collected by a nurse from the patient and sent to the laboratory for nucleic acid amplification testing specific for Chlamydia pneumoniae. The lab analyst performs 87486 using an amplified nucleic acid probe technique; results are reported to the ordering clinician to guide targeted therapy and public health reporting when indicated. Typical sites of service are hospital outpatient laboratories, independent clinical laboratories, and ambulatory clinic laboratories. The encounter includes specimen collection, transport to the lab, molecular testing by trained laboratory personnel, and result reporting in the electronic medical record to the ordering provider.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation component if applicable in split-billing situations. |
TC |