Summary & Overview
CPT 87529: Herpes Simplex Virus, Amplified Nucleic Acid Probe
CPT code 87529 represents a molecular diagnostic assay for Herpes simplex virus (HSV) using an amplified nucleic acid probe. This test is clinically important for confirming active HSV infection, guiding treatment decisions, and informing infection control because HSV causes recurrent vesicular lesions and can be transmitted person-to-person. Nationally, molecular detection methods like those captured by CPT code 87529 are widely used in outpatient and laboratory settings for rapid, sensitive identification of HSV.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, common sites of service, and the test’s role in diagnosis. The publication outlines typical billing and payment considerations, common modifier usage patterns (listed separately), and benchmarking highlights where available. Policy updates affecting laboratory molecular diagnostics and coding guidance relevant to nucleic acid amplification tests are summarized to help billing staff and laboratory managers understand reimbursement environment and documentation expectations.
This article is written for a national audience and focuses on clinical and billing context, payer coverage considerations, and operational implications for laboratories and outpatient practices.
Billing Code Overview
CPT code 87529 describes a laboratory test for Herpes simplex virus (HSV) using an amplified nucleic acid probe technique. The procedure detects HSV genetic material to diagnose active infection that often causes clusters of blisters or vesicles on skin and mucous membranes.
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Service type: Molecular diagnostic test (nucleic acid amplification)
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Typical site of service: Clinical laboratory or outpatient specimen collection (e.g., clinic, urgent care) with testing performed in a certified laboratory
Clinical & Coding Specifications
Clinical Context
A patient presents to an urgent care or outpatient clinic with acute painful grouped vesicular lesions on the lip, mouth, genitalia, or perioral/perineal skin. The clinician performs a focused history and exam noting clusters of vesicles and erythema consistent with possible primary or recurrent Herpes simplex virus (HSV) infection. A swab of a fresh lesion is collected and sent to the laboratory for an amplified nucleic acid probe test for HSV, billed with 87529. The typical workflow: clinician documents lesion appearance and indication for testing, obtains informed consent for specimen collection, collects a swab of vesicular fluid or base of an ulcer using recommended technique, labels and submits the specimen to the clinical laboratory, and orders 87529 for HSV detection by nucleic acid amplification. Results are returned to the ordering clinician who documents interpretation and any treatment decisions. Typical sites of service include outpatient clinics, urgent care centers, emergency departments, and hospital laboratories performing the diagnostic assay. Typical patient scenario: an adult with new-onset painful genital blisters after sexual contact; a pregnant patient with orolabial lesions requiring HSV testing to guide peripartum management; or an immunocompromised patient with atypical cutaneous lesions requiring laboratory confirmation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 |