CPT 87492: Chlamydia trachomatis Quantitative Nucleic Acid Probe Test
CPT code 87492 represents a quantified nucleic acid probe test for Chlamydia trachomatis, a common sexually transmitted bacterium that also causes certain ocular infections. The code captures a laboratory assay performed by an analyst to detect and quantify Chlamydia trachomatis genetic material using probe-based nucleic acid methods. This test supports diagnosis, treatment decisions, and public health surveillance for chlamydial infection.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national perspective on clinical context, typical sites of service, and the role of nucleic acid probe testing in managing sexually transmitted and ocular chlamydial infections. The publication outlines common billing considerations, prevalent modifier usage (provided in input), and how this laboratory service integrates with clinical workflows.
The report provides benchmarks where available, summarizes relevant policy and coverage themes for major payers, and situates CPT code 87492 within diagnostic testing practice. Data not available in the input will be noted as such in detailed sections.
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Billing Code Overview
CPT code 87492 describes a laboratory procedure in which a lab analyst performs a nucleic acid probe test to quantify infection with Chlamydia trachomatis. The test detects and measures the presence of Chlamydia trachomatis genetic material using probe-based nucleic acid techniques.
Service type: Infectious disease diagnostic laboratory test (nucleic acid probe, quantitative)
Typical site of service: Clinical laboratory or hospital laboratory; specimen collection may occur in outpatient clinics, sexual health clinics, or ophthalmology settings for eye infections
Clinical & Coding Specifications
Clinical Context
A sexually active adult female presents to a primary care clinic with dysuria, vaginal discharge, and pelvic pain. The clinician performs a focused sexual health history and pelvic exam, collects a cervical or vaginal swab (or first-catch urine for nucleic acid testing), and sends the specimen to the laboratory for nucleic acid probe testing to detect and quantify infection with Chlamydia trachomatis. The laboratory analyst processes the specimen using a nucleic acid probe technique and reports a quantitative result to the ordering clinician. Typical workflow steps include specimen collection at the outpatient clinic or STI clinic, specimen labeling and transport to the clinical laboratory, performance of the 87492 nucleic acid probe assay by laboratory personnel, quality control and verification, and result reporting into the electronic health record for clinical follow-up and treatment decisions. Typical site of service is an outpatient clinic, sexual health/STI clinic, or hospital outpatient laboratory. Common clinical scenarios also include screening of asymptomatic patients during routine sexual health visits, testing of symptomatic patients with cervicitis or urethritis, and testing of neonates or infants with conjunctivitis when ocular Chlamydia infection is suspected.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the professional interpretation component separate from the technical component |
59 | Distinct procedural service | When the 87492 test is distinct and separate from another service on the same day |
76 | Repeat procedure by same physician | When the same lab performs a repeat 87492 assay during the same episode |
77 | Repeat procedure by another physician | When a different lab or provider repeats the 87492 assay |
90 | Reference (outside) laboratory | When the specimen is sent to an outside reference lab that performs the 87492 test |
91 | Repeat clinical diagnostic laboratory test | When the test is repeated on the same specimen or within a short interval for verification |
52 | Reduced services | When an abbreviated or partial 87492 testing procedure is performed |
53 | Discontinued procedure | When the 87492 test was started but discontinued for clinical reasons |
59 | Distinct procedural service | (duplicate entry avoided in practice; see coding guidance above) |
TC | Technical component | When billing only the technical component (laboratory work and supplies) of the assay |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207Q00000X | Obstetrics & Gynecology | OB/GYN clinicians commonly collect specimens and order testing for Chlamydia trachomatis |
| 208D00000X | Family Medicine | Family physicians routinely screen and manage sexually transmitted infections |
| 207L00000X | Infectious Disease | ID specialists interpret complex or persistent Chlamydia infections and oversee management |
| 335C00000X | Clinical Pathology | Laboratory pathologists and clinical laboratory scientists perform and oversee nucleic acid probe testing |
| 163W00000X | Pediatrics | Pediatricians may order testing for neonatal conjunctivitis or adolescent screening |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
A74.9 | Chlamydial infection, unspecified | Primary diagnostic indication for ordering nucleic acid testing for Chlamydia trachomatis |
N76.0 | Acute vaginitis | Vaginal symptoms prompting testing for sexually transmitted pathogens including Chlamydia |
N34.1 | Urethritis, unspecified | Male or female urethral symptoms leading to Chlamydia testing |
A54.02 | Gonococcal infection of lower genitourinary tract, unspecified | Frequently co-tested with Chlamydia due to overlapping presentation |
H12.0 | Conjunctivitis due to Chlamydia trachomatis | Ocular infection scenario where 87492 may be used for diagnosis |
Z11.3 | Encounter for screening for infections with a predominantly sexual mode of transmission | Routine screening encounter where Chlamydia NAAT/probe testing is ordered |
Z20.2 | Contact with and (suspected) exposure to infections with a predominantly sexual mode of transmission | Post-exposure testing indication for Chlamydia |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
87491 | Infectious agent detection by nucleic acid (e.g., Chlamydia trachomatis), amplified probe technique; direct probe technique, qualitative or presuming qualitative result | Often used as an alternative method for Chlamydia testing; may be ordered instead of or in addition to 87492 depending on laboratory methodology |
87591 | Infectious agent detection by nucleic acid (e.g., Neisseria gonorrhoeae), amplified probe technique; direct probe technique, qualitative or presuming qualitative result | Frequently ordered alongside 87492 for co-testing of gonorrhea and chlamydia from the same specimen |
36415 | Collection of venous blood by venipuncture | May be performed at the same visit when additional serologic testing (HIV, syphilis) is ordered with 87492 |
87880 | Infectious agent antigen detection by immunoassay technique, multiple-step method; chlamydia trachomatis | Alternative lab method for Chlamydia detection; may be used in different lab workflows |
G0003 | Physician certification or recertification for Medicare home health/homebound status (example not directly related) | Data not available in the input. |