Summary & Overview
CPT 87520: Hepatitis C Direct Nucleic Acid Probe Test
CPT code 87520 designates a laboratory molecular diagnostic test that uses a direct nucleic acid probe technique to detect hepatitis C viral material. This diagnostic procedure is important for confirming active hepatitis C infection, guiding clinical management, and supporting public health surveillance. Molecular confirmation of hepatitis C remains a critical component of hepatitis C care pathways and is widely performed in clinical and hospital laboratory settings.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise national overview of what CPT code 87520 represents, payer coverage patterns, and the clinical context for use. The publication outlines where this service is typically performed, common billing modifiers and service-line considerations, and links to related laboratory coding practices.
This summary provides the essential coding description and service context; detailed benchmarks, policy updates, and payer-specific coverage nuances are presented in the main publication. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 87520 describes a laboratory procedure in which a laboratory analyst performs a test for hepatitis C using a direct nucleic acid probe technique. This service is a molecular diagnostic test for detection of hepatitis C viral nucleic acid sequences.
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Service type: Laboratory molecular diagnostic testing
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Typical site of service: Clinical laboratory or hospital laboratory setting
Clinical & Coding Specifications
Clinical Context
A typical patient is a 45-year-old adult presenting to an outpatient clinic or ambulatory laboratory with suspected or known hepatitis C virus (HCV) infection. Indications include elevated liver enzymes, positive HCV antibody screening, exposure risk (history of intravenous drug use, blood transfusion prior to 1992, hemodialysis), or evaluation of treatment response. The clinician orders a nucleic acid probe test to detect HCV RNA for confirmation of active infection or to quantify viral presence when required by the lab technique. A phlebotomy technician collects a blood specimen, which is transported to the clinical laboratory. A medical laboratory scientist or lab analyst performs the 87520 assay using a direct nucleic acid probe technique. Results are reported to the ordering provider for clinical decision-making, including treatment initiation, monitoring antiviral therapy, or epidemiologic reporting. Typical sites of service include outpatient laboratories, hospital clinical laboratories, public health labs, and ambulatory clinic-based lab draw stations.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional (interpretation) portion if separated from the technical component. |