Summary & Overview
CPT 87491: Chlamydia trachomatis Test by Amplified Nucleic Acid Probe
CPT code 87491 represents a laboratory diagnostic assay for Chlamydia trachomatis using an amplified nucleic acid probe technique. This molecular test is widely used for accurate detection of a common sexually transmitted infection and informs clinical management, public health screening, and reporting. Its use has national relevance due to the prevalence of Chlamydia infections and the role of nucleic acid amplification tests in recommended screening strategies.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, common service settings, and the types of benchmarks and policy considerations typically associated with molecular diagnostic billing for sexually transmitted infections. The publication covers reimbursement benchmarks, applicable coding guidance, and payer policy highlights that affect coverage and payment for amplified nucleic acid probe testing.
The piece provides practical reference material for billing staff, laboratory managers, and policy analysts seeking to understand where this code fits within laboratory service lines, how major payers approach coverage, and what operational considerations—such as typical settings and test purpose—are relevant for compliance and claims processing. Data not available in the input is explicitly noted where applicable.
Billing Code Overview
CPT code 87491 describes a laboratory test performed by a lab analyst to detect Chlamydia trachomatis using an amplified nucleic acid probe technique. This is a molecular diagnostic assay that identifies genetic material specific to the pathogen.
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Service type: Laboratory diagnostic test (amplified nucleic acid probe)
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Typical site of service: Clinical laboratory or hospital laboratory setting where molecular testing is performed
Clinical & Coding Specifications
Clinical Context
A sexually active 24-year-old female presents to a community sexual health clinic for routine sexually transmitted infection (STI) screening after reporting new sexual partners. She denies symptoms but requests testing. A urine nucleic acid amplification test (NAAT) is ordered for Chlamydia trachomatis. The clinic collects a first-catch urine specimen and sends it to the on-site or reference laboratory. The laboratory analyst performs the amplified nucleic acid probe technique to detect C. trachomatis RNA/DNA. Results are reported back to the ordering clinician; positive results prompt partner notification and treatment per local public health guidance. Typical workflow roles include: clinician/patient encounter and specimen collection in an ambulatory clinic or urgent care setting, courier transport (if performed off-site), and laboratory processing and reporting in a clinical microbiology or molecular diagnostics lab. Typical site of service: ambulatory clinic, urgent care center, or clinical laboratory performing diagnostic testing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional (interpretive) portion of a lab test if separated from technical component. |
TC |