Summary & Overview
CPT 87523: Hepatitis D (Delta) Viral Load, Quantitative
CPT code 87523 is a laboratory molecular diagnostic code for quantitative measurement of hepatitis D (delta) viral load using a nucleic acid probe technique. Nationally, accurate quantification of hepatitis D virus (HDV) guides clinical assessment of disease severity in patients with concurrent hepatitis B infection and informs monitoring and therapeutic decision-making where available. Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. This publication provides a concise overview of the code's clinical context, typical sites of service, and what payers commonly cover. Readers will find benchmark information on coverage and reimbursement patterns, discussion of clinical utility and indications, and recent policy or coding updates relevant to molecular viral load testing. The summary also outlines operational considerations for laboratories and clinical teams submitting claims for this service. Data gaps in the input are noted where specific payer policies, taxonomies, ICD-10 pairings, and related codes are not provided.
Billing Code Overview
CPT code 87523 describes a nucleic acid (DNA or RNA) probe technique used to quantify hepatitis D (delta) viral load in a patient specimen. The test measures the amount of hepatitis D virus genetic material to determine viral burden, which is clinically relevant because hepatitis D infection occurs only in patients with active hepatitis B infection and can worsen disease severity.
Service Type: Molecular diagnostic viral load testing
Typical Site of Service: Clinical laboratory or hospital laboratory
Data not available in the input for payers, associated taxonomies, ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A 42-year-old patient with chronic hepatitis B infection presents for evaluation of worsening liver enzymes and new onset fatigue. The clinician orders a quantitative hepatitis D viral load to determine active hepatitis D virus (HDV) replication because HDV only occurs with hepatitis B virus (HBV) co-infection and can accelerate liver injury. A phlebotomy technician collects a blood specimen in an appropriate viral transport tube; the specimen is sent to a molecular diagnostics laboratory. In the lab, a nucleic acid amplification test using a DNA/RNA probe quantifies HDV RNA and reports viral load in international units per milliliter. Results are provided to the ordering provider and placed in the medical record to guide disease staging and antiviral or referral decisions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the professional interpretation portion if the laboratory separates professional and technical components. |
52 | Reduced services | When the test is partially performed or abbreviated and the full service was not completed for documented reasons.
53 | Discontinued procedure | When specimen collection or testing was started but discontinued due to patient or technical reasons.