Summary & Overview
CPT 87495: Cytomegalovirus Detection by Direct Nucleic Acid Probe
Headline: CPT code 87495: Molecular Diagnostic Test for Cytomegalovirus Detection
Lead: CPT code 87495 identifies a laboratory assay that uses a direct nucleic acid probe to detect cytomegalovirus (CMV) genetic material. CMV testing is clinically important because infections can cause significant morbidity in newborns and immunocompromised patients, and accurate molecular detection supports timely diagnosis and management.
CPT code 87495 represents a targeted molecular diagnostic procedure performed in clinical or hospital laboratories to identify CMV. Nationally, CMV testing is a routine part of perinatal and transplant infectious disease evaluation and carries implications for neonatal care, transplant management, and infection control. Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find an overview of clinical context for CMV nucleic acid probe testing, expected sites of service, and the types of information payers typically evaluate for laboratory coverage decisions. The publication summarizes benchmark pricing and utilization context where available, highlights relevant billing considerations for laboratory services, and outlines areas where policy updates or payer guidance can affect reimbursement and coding practice. Data not available in the input is noted where specific payer policies, associated taxonomies, ICD-10 diagnoses, and related codes are not present.
Billing Code Overview
CPT code 87495 describes a laboratory test for cytomegalovirus (CMV) performed using a direct nucleic acid probe technique. The service involves analysis of patient specimen material in a clinical laboratory to detect CMV genetic material, a pathogen that can cause severe illness in newborns and immunocompromised patients.
Service type: Laboratory diagnostic test (microbiology/molecular diagnostic)
Typical site of service: Clinical laboratory or hospital laboratory setting, including outpatient laboratory facilities where specimen processing and molecular diagnostic testing are performed.
Clinical & Coding Specifications
Clinical Context
A newborn infant or an immunocompromised adult presents with signs suggestive of cytomegalovirus (CMV) infection. Common scenarios include a neonate with petechiae, hepatosplenomegaly, intrauterine growth restriction, or sensorineural hearing loss screening concern; or an adult transplant recipient or patient with advanced HIV experiencing fever, malaise, organ-specific symptoms (retinitis, pneumonitis, colitis) where CMV is in the differential. A clinician orders laboratory testing to detect active CMV infection using a direct nucleic acid probe technique performed by the laboratory analyst. The specimen is typically a swab, body fluid, tissue, or blood sample collected in the inpatient neonatal unit, outpatient specialty clinic (infectious disease, transplant clinic), or hospital laboratory. The lab receives the specimen, performs the direct nucleic acid probe assay for CMV, documents test results in the laboratory information system, and communicates positive or negative findings to the ordering clinician for clinical correlation and management decisions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional interpretation component if applicable (rare for this assay). |
59 |