Summary & Overview

CPT 87513: H. pylori Detection with Clarithromycin Resistance, Amplified NA Probe

CPT code 87513 covers a molecular diagnostic assay that detects Helicobacter pylori infection and determines clarithromycin resistance using an amplified nucleic acid probe technique. This code is important nationally because H. pylori is a common pathogen linked to peptic ulcer disease and gastric inflammation, and detection of clarithromycin resistance informs antibiotic selection and stewardship. The test supports targeted therapy and can affect clinical outcomes and antimicrobial resistance management across care settings.

Key payers analyzed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find information about clinical context, typical sites of service, and payer coverage considerations. The publication provides benchmarks and reimbursement context where available, summarizes coding and billing implications for laboratory and hospital settings, and highlights policy and utilization trends relevant to molecular infectious-disease testing. Data not available in the input will be noted as such in the relevant sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare87513CPTmolecular-diagnosticshelicobacter-pyloriclarithromycin-resistanceinfectious-disease-testinglaboratoryantimicrobial-stewardship

Billing Code Overview

CPT code 87513 describes a laboratory test that detects Helicobacter pylori infection using an amplified nucleic acid probe technique and also identifies resistance to the antibiotic clarithromycin. The service type is a molecular diagnostic assay for infectious disease detection and antimicrobial resistance. The typical site of service is a clinical laboratory or hospital laboratory performing molecular testing on patient specimens.

Clinical & Coding Specifications

Clinical Context

A 45-year-old patient presents to a gastroenterology clinic with several months of epigastric pain, dyspepsia, occasional nausea, and a recent episode of melena. The gastroenterologist orders a noninvasive molecular test for Helicobacter pylori using an amplified nucleic acid probe technique that also detects clarithromycin resistance. A specimen (stool or gastric biopsy tissue placed in transport medium) is collected in clinic or at an outpatient laboratory and sent to a clinical molecular laboratory. The lab analyst performs 87513 to detect H. pylori DNA and assess clarithromycin resistance mutations. Results are reported to the ordering provider; a positive H. pylori with clarithromycin resistance influences antibiotic selection for eradication therapy. Typical site of service includes outpatient clinic, hospital outpatient laboratory, or reference molecular diagnostics laboratory. Typical workflow: specimen collection → specimen accessioning and molecular preparation → nucleic acid amplification and probe detection for H. pylori and resistance markers → result validation and reporting to ordering clinician.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when reporting only the professional interpretation component if the technical component is billed separately.
`TC`	Technical component	Use when billing only the technical component (equipment, technician, supplies) and the professional component is billed separately.
`90`	Reference (outside) laboratory	Use when the service is performed by an outside or reference laboratory under contract.
`QX`	Qualified non-physician practitioner	Use when a qualified non-physician practitioner performs the service under appropriate supervision, where applicable.
`QK`	Medical direction of 2–4 technicians	Use when the physician medically directs multiple qualified technicians performing the test.
`QY`	Hospital-based intensive outpatient services	Use per payer rules when applicable to non-physician performed services in certain settings (apply only if payer recognizes modifier).
`62`	Two surgeons	Rare for this lab test but used when two surgeons share responsibility for a surgical service that leads to intraoperative testing.
`52`	Reduced services	Use if the test was partially performed or specimen inadequate leading to a reduced service.
`53`	Discontinued procedure	Use when testing was started but discontinued for patient-related or specimen issues.
`78`	Unplanned return to the operating/procedure room	Use if testing is part of intraoperative services and unplanned return occurs requiring repeat testing.
`90`	Reference (outside) laboratory	Use when the test was performed by an outside lab (listed again for emphasis; use once per claim as applicable).

Taxonomy Code	Specialty	Notes
207RH0000X	Pathology	Clinical pathologists and molecular pathologists commonly oversee molecular infectious disease testing.
208000000X	Gastroenterology	Gastroenterologists order H. pylori testing as part of dyspepsia/ulcer workup.
363L00000X	Laboratory Director	Laboratory directors and clinical laboratory specialists manage lab operations and compliance for molecular tests.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K29.70`	Gastritis, unspecified, without bleeding	Common indication for H. pylori testing in patients with dyspepsia and suspected gastritis.
`K29.50`	Gastritis, unspecified, with bleeding	H. pylori is a recognized cause of bleeding gastritis and ulceration prompting diagnostic testing.
`K25.9`	Gastric ulcer, unspecified, without bleeding or perforation	Peptic ulcer disease evaluation includes testing for H. pylori as an etiologic factor.
`K26.9`	Duodenal ulcer, unspecified, without bleeding or perforation	Duodenal ulcers are commonly linked to H. pylori infection; testing guides therapy.
`R11.0`	Nausea and vomiting	Nonspecific GI symptoms that can prompt evaluation including H. pylori testing when dyspepsia is present.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`87480`	Helicobacter pylori; immunoassay for antigen	Alternative non-molecular stool antigen test often ordered for H. pylori detection when molecular testing is not used.
`87338`	Helicobacter pylori antibody; qualitative or semiquantitative	Serologic test that may be ordered in some settings but has limitations compared with molecular or stool antigen testing.
`88305`	Surgical pathology, gross and microscopic examination	Used when gastric biopsy tissue is processed for histology in addition to molecular testing for H. pylori.
`87177`	Culture, bacterial, with isolation and presumptive identification	Used when culture-based methods are attempted for H. pylori and antibiotic susceptibility beyond clarithromycin is required.
`82542`	Ammonia; qualitative or quantitative	Occasionally used adjunctively in metabolic evaluation related to Helicobacter-associated disease in inpatient settings.