Summary & Overview
CPT 87522: Hepatitis C Viral Load, Quantitative
CPT code 87522 represents a quantitative molecular diagnostic assay to measure hepatitis C virus (HCV) RNA in a patient's specimen, commonly referred to as an HCV viral load. This test is clinically important for confirming active infection, guiding antiviral therapy initiation, and monitoring response to treatment, making it a high-priority lab service across clinical and public health settings.
Key national payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines how coverage and payment for CPT code 87522 affect access to HCV diagnosis and management under major commercial and federal insurers.
Readers will find a concise overview of the code’s clinical purpose and typical site of service, plus benchmarking content on utilization and reimbursement patterns where available. The report also summarizes policy and coding considerations relevant to laboratories, clinicians, and billing teams, and provides context for interpreting test ordering and follow-up. Data not available in the input is noted where applicable; the content focuses on national implications rather than state-specific rules.
Billing Code Overview
CPT code 87522 describes a laboratory test that measures the amount of hepatitis C virus (HCV) present in a patient’s specimen, commonly reported as HCV viral load. The service type is molecular diagnostic testing for viral quantification, which involves nucleic acid amplification or similar techniques to determine viral RNA concentration.
Typical site of service is clinical laboratory or hospital-based laboratory where blood or other appropriate specimens are processed and analyzed. The test is used to assess infection status, guide antiviral treatment decisions, and monitor treatment response.
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient with known chronic hepatitis C infection presents for routine monitoring prior to and during antiviral therapy. The clinician orders a quantitative HCV RNA test to determine baseline viral load and to monitor virologic response at weeks 4, 12, and 24 of therapy. A phlebotomist collects a serum specimen in an outpatient clinic or ambulatory lab; the specimen is transported to the clinical laboratory where nucleic acid amplification testing is performed to quantify hepatitis C virus RNA. Results are returned to the ordering provider, who uses the viral load to guide treatment decisions and to document sustained virologic response after therapy completion.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting only the physician interpretation of a laboratory result if split billing applies (rare for automated viral load assays). |
90 | Reference (outside) laboratory | When the specimen is sent to an outside reference laboratory for testing. |