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CPT 87516: Hepatitis B Virus Nucleic Acid Probe Test

CPT code 87516 represents a molecular diagnostic assay that detects hepatitis B virus (HBV) using an amplified nucleic acid probe technique. This test identifies viral nucleic acid to support diagnosis of acute or chronic HBV infection and informs clinical management of liver disease. On a national scale, accurate and timely HBV molecular testing is critical for public health surveillance, treatment decisions, and preventing transmission.

Key payers addressed in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a focused overview of the clinical context for HBV nucleic acid testing, the typical laboratory setting where the test is performed, and payer coverage considerations. The publication summarizes available benchmarking metrics, common billing practices, and recent policy updates affecting molecular infectious disease testing where data is available.

The content is organized to provide: (1) clinical rationale for the assay and typical use cases; (2) operational considerations for laboratory service lines; (3) payer coverage and coding considerations; and (4) what is known about reimbursement patterns and policy changes. Data not provided in the input are identified as such, and the document emphasizes nationally relevant information for clinicians, laboratory administrators, and coding professionals.

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Billing Code Overview

CPT code 87516 describes a laboratory test that detects hepatitis B virus (HBV) using an amplified nucleic acid probe technique. The procedure is a molecular diagnostic assay performed by a laboratory analyst to identify HBV nucleic acid, which is relevant for diagnosing acute or chronic hepatitis B infection and for monitoring viral presence.

Service Type: Molecular diagnostic laboratory test (amplified nucleic acid probe technique)

Typical Site of Service: Clinical laboratory, hospital laboratory, or reference diagnostic laboratory

Data not available in the input.

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CPT 87516: Hepatitis B Virus Nucleic Acid Probe Test

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Billing Code Overview

Service Type: Molecular diagnostic laboratory test (amplified nucleic acid probe technique)

Typical Site of Service: Clinical laboratory, hospital laboratory, or reference diagnostic laboratory

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 34-year-old patient presents to an outpatient infectious disease clinic after a needlestick exposure at work. The clinician orders a sensitive laboratory assay to detect hepatitis B virus (HBV) nucleic acid to evaluate possible acute infection and to guide post-exposure management. The specimen is collected (typically a venous blood draw) and sent to a molecular diagnostics laboratory. A molecular technologist performs an amplified nucleic acid probe technique to detect HBV DNA, documents results in the laboratory information system, and the ordering clinician reviews the result to determine need for antiviral therapy, immunoprophylaxis, or further follow-up.

Service Type: Molecular diagnostic laboratory test using amplified nucleic acid probe technique for hepatitis B virus.

Typical Site of Service: Hospital outpatient laboratory, independent reference laboratory, or hospital inpatient laboratory performing molecular virology testing.

Typical Patient Scenario: Testing is commonly ordered for symptomatic patients with acute hepatitis signs (jaundice, elevated liver enzymes), occupational exposures, evaluation of suspected perinatal transmission, or monitoring possible breakthrough infection in patients with immunosuppression.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the professional interpretation component if the performing facility bills separately for the technical component.
`TC`	Technical component	Use when billing only the technical component (laboratory processing and instrumentation) and the professional interpretation is reported separately.
`91`	Repeat clinical diagnostic laboratory test	Use when the same test is repeated on the same day for follow-up or validation purposes.
`59`	Distinct procedural service	Use when this test is separately identifiable from other services on the same day (different specimens/tests).
`90`	Reference (outside) laboratory	Use when the specimen is sent to an outside/reference laboratory and another lab performed the test.
`91`	Duplicate test (note: already listed)	Use for repeated testing to obtain a reliable result (retain single listing in billing).
`22`	Increased procedural services	Use when documented work or resources exceed typical laboratory complexity (rare for automated HBV NAAT but applicable for manual reflexes).
`52`	Reduced services	Use when the test was partially performed or specimen inadequate and only partial testing completed.
`59`	Distinct service (note: already listed)	Use to indicate a procedurally distinct service (avoid duplicate entries).
`QK`	CLIA waived testing performed by non-laboratory personnel	Use if applicable for certain waived point-of-care nucleic acid tests when regulatory criteria met.

Taxonomy Code	Specialty	Notes
207Q00000X	Infectious Disease	Clinicians who order HBV molecular testing for diagnosis and management.
207L00000X	Pathology & Laboratory Medicine	Laboratory directors and pathologists overseeing molecular diagnostics.
208000000X	Internal Medicine	Primary care and hospitalists ordering HBV testing during acute illness or screening.
207K00000X	Pediatrics	Pediatricians ordering HBV testing for perinatal exposure evaluation and pediatric hepatitis.
174400000X	Occupational Medicine	Occupational health specialists managing needlestick exposures and employee testing.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`B16.9`	Acute hepatitis B without delta-agent, without hepatic coma	Acute HBV infection prompting nucleic acid testing to confirm viremia and assist in staging.
`B18.1`	Chronic viral hepatitis B without delta-agent	Monitoring and evaluation of chronic HBV patients for viral load and treatment decisions.
`Z20.6`	Contact with and (suspected) exposure to viral hepatitis	Occupational or household exposures that prompt nucleic acid testing for HBV.
`P04.3`	Newborn (suspected to be) affected by maternal infectious disease, transmitted from mother	Neonates born to HBV-positive mothers require HBV testing to assess perinatal transmission.
`D73.2`	Chronic passive congestion of liver (include hepatic dysfunction)	Patients with liver disease of unclear etiology may be tested for HBV as part of workup.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`87622`	Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, amplified probe technique, single reportable analyte	Performed for concurrent evaluation of blood-borne viral exposures when assessing need for comprehensive post-exposure testing.
`87536`	Infectious agent detection by nucleic acid (DNA or RNA); Hepatitis C virus, amplified probe technique	Often ordered alongside HBV nucleic acid testing for complete hepatitis evaluation.
`80053`	Comprehensive metabolic panel (CMP)	Provides liver function tests (ALT/AST, bilirubin) used concurrently to assess hepatic injury when HBV infection is suspected.
`86704`	Hepatitis B surface antigen (HBsAg)	Serologic test frequently ordered before or alongside HBV nucleic acid testing to determine active infection status.
`86706`	Hepatitis B core antibody (anti-HBc) total	Serologic marker used to determine prior exposure or acute infection phase in conjunction with molecular testing.

CPT 87260: Adenovirus Antigen Detection by Immunofluorescence

CPT-87265-BORDETELLA-IMMUNOFLUORESCENT-ANTIGEN-DETECTION

CPT 87265: Immunofluorescent Antigen Detection for Bordetella

CPT-87267-ENTEROVIRUS-DFA-ANTIGEN-DETECTION

CPT 87267: Enterovirus Antigen Detection by Direct Fluorescent Antibody

CPT-87269-GIARDIA-IMMUNOFLUORESCENT-ANTIGEN-DETECTION

CPT 87269: Immunofluorescent Detection of Giardia Antigen

CPT-87270-CHLAMYDIA-TRACHOMATIS-IMMUNOFLUORESCENT-ANTIGEN-DETECTION

CPT 87270: Chlamydia trachomatis Antigen Detection by Immunofluorescence

CPT-87271-CMV-DFA-ANTIGEN-DETECTION

CPT 87271: Cytomegalovirus Antigen Detection by DFA

CPT-87272-CRYPTOSPORIDIUM-IMMUNOFLUORESCENT-ANTIGEN-DETECTION

CPT 87272: Cryptosporidium Antigen Immunofluorescent Test

CPT-87273-HSV-2-ANTIGEN-IMMUNOFLUORESCENCE

CPT 87273: HSV-2 Antigen Detection by Immunofluorescence

CPT-87274-HSV-1-ANTIGEN-IMMUNOFLUORESCENCE

CPT 87274: HSV-1 Antigen Detection by Immunofluorescence

CPT-87275-INFLUENZA-B-IMMUNOFLUORESCENT-ANTIGEN-DETECTION

CPT 87275: Influenza B Antigen Detection by Immunofluorescence

Showing 1–10 of 167

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

Service Type: Molecular diagnostic laboratory test using amplified nucleic acid probe technique for hepatitis B virus.

Typical Site of Service: Hospital outpatient laboratory, independent reference laboratory, or hospital inpatient laboratory performing molecular virology testing.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the professional interpretation component if the performing facility bills separately for the technical component.
`TC`	Technical component	Use when billing only the technical component (laboratory processing and instrumentation) and the professional interpretation is reported separately.
`91`	Repeat clinical diagnostic laboratory test	Use when the same test is repeated on the same day for follow-up or validation purposes.
`59`	Distinct procedural service	Use when this test is separately identifiable from other services on the same day (different specimens/tests).
`90`	Reference (outside) laboratory	Use when the specimen is sent to an outside/reference laboratory and another lab performed the test.
`91`	Duplicate test (note: already listed)	Use for repeated testing to obtain a reliable result (retain single listing in billing).
`22`	Increased procedural services	Use when documented work or resources exceed typical laboratory complexity (rare for automated HBV NAAT but applicable for manual reflexes).
`52`	Reduced services	Use when the test was partially performed or specimen inadequate and only partial testing completed.
`59`	Distinct service (note: already listed)	Use to indicate a procedurally distinct service (avoid duplicate entries).
`QK`	CLIA waived testing performed by non-laboratory personnel	Use if applicable for certain waived point-of-care nucleic acid tests when regulatory criteria met.

Taxonomy Code	Specialty	Notes
207Q00000X	Infectious Disease	Clinicians who order HBV molecular testing for diagnosis and management.
207L00000X	Pathology & Laboratory Medicine	Laboratory directors and pathologists overseeing molecular diagnostics.
208000000X	Internal Medicine	Primary care and hospitalists ordering HBV testing during acute illness or screening.
207K00000X	Pediatrics	Pediatricians ordering HBV testing for perinatal exposure evaluation and pediatric hepatitis.
174400000X	Occupational Medicine	Occupational health specialists managing needlestick exposures and employee testing.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`B16.9`	Acute hepatitis B without delta-agent, without hepatic coma	Acute HBV infection prompting nucleic acid testing to confirm viremia and assist in staging.
`B18.1`	Chronic viral hepatitis B without delta-agent	Monitoring and evaluation of chronic HBV patients for viral load and treatment decisions.
`Z20.6`	Contact with and (suspected) exposure to viral hepatitis	Occupational or household exposures that prompt nucleic acid testing for HBV.
`P04.3`	Newborn (suspected to be) affected by maternal infectious disease, transmitted from mother	Neonates born to HBV-positive mothers require HBV testing to assess perinatal transmission.
`D73.2`	Chronic passive congestion of liver (include hepatic dysfunction)	Patients with liver disease of unclear etiology may be tested for HBV as part of workup.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`87622`	Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, amplified probe technique, single reportable analyte	Performed for concurrent evaluation of blood-borne viral exposures when assessing need for comprehensive post-exposure testing.
`87536`	Infectious agent detection by nucleic acid (DNA or RNA); Hepatitis C virus, amplified probe technique	Often ordered alongside HBV nucleic acid testing for complete hepatitis evaluation.
`80053`	Comprehensive metabolic panel (CMP)	Provides liver function tests (ALT/AST, bilirubin) used concurrently to assess hepatic injury when HBV infection is suspected.
`86704`	Hepatitis B surface antigen (HBsAg)	Serologic test frequently ordered before or alongside HBV nucleic acid testing to determine active infection status.
`86706`	Hepatitis B core antibody (anti-HBc) total	Serologic marker used to determine prior exposure or acute infection phase in conjunction with molecular testing.

CPT 87260: Adenovirus Antigen Detection by Immunofluorescence

CPT-87265-BORDETELLA-IMMUNOFLUORESCENT-ANTIGEN-DETECTION

CPT 87265: Immunofluorescent Antigen Detection for Bordetella

CPT-87267-ENTEROVIRUS-DFA-ANTIGEN-DETECTION

CPT 87267: Enterovirus Antigen Detection by Direct Fluorescent Antibody

CPT-87269-GIARDIA-IMMUNOFLUORESCENT-ANTIGEN-DETECTION

CPT 87269: Immunofluorescent Detection of Giardia Antigen

CPT-87270-CHLAMYDIA-TRACHOMATIS-IMMUNOFLUORESCENT-ANTIGEN-DETECTION

CPT 87270: Chlamydia trachomatis Antigen Detection by Immunofluorescence

CPT-87271-CMV-DFA-ANTIGEN-DETECTION

CPT 87271: Cytomegalovirus Antigen Detection by DFA

CPT-87272-CRYPTOSPORIDIUM-IMMUNOFLUORESCENT-ANTIGEN-DETECTION

CPT 87272: Cryptosporidium Antigen Immunofluorescent Test

CPT-87273-HSV-2-ANTIGEN-IMMUNOFLUORESCENCE

CPT 87273: HSV-2 Antigen Detection by Immunofluorescence

CPT-87274-HSV-1-ANTIGEN-IMMUNOFLUORESCENCE

CPT 87274: HSV-1 Antigen Detection by Immunofluorescence

CPT-87275-INFLUENZA-B-IMMUNOFLUORESCENT-ANTIGEN-DETECTION

CPT 87275: Influenza B Antigen Detection by Immunofluorescence

Showing 1–10 of 167

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 87516: Hepatitis B Virus Nucleic Acid Probe Test

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Billing Code Overview

OpenPayer

CPT 87516: Hepatitis B Virus Nucleic Acid Probe Test

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References