Summary & Overview
CPT 87551: Mycobacterium Detection by Amplified Nucleic Acid Probe
CPT code 87551 designates an amplified nucleic acid probe test for detection of Mycobacterium species. This molecular diagnostic code is used in microbiology laboratories to identify acid-fast bacteria that cause diseases such as tuberculosis and non-tuberculous mycobacterial infections. Nationally, accurate molecular identification of Mycobacterium species supports appropriate public health responses, infection control, and targeted antimicrobial therapy.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage and reimbursement policies for molecular microbiology tests vary by payer and setting; this report summarizes typical coverage constructs and operational considerations used by major commercial and government payers.
Readers will learn the clinical context for use of CPT code 87551, expected sites of service, and the types of benchmarks and policy topics typically relevant to this code (coverage policies, laboratory billing practices, and coding relationships). Where specific payer or coding detail is not provided in the input, the report will note that the information is not available. The overview supports laboratory administrators, coding professionals, and policy analysts who need concise clinical and billing context for CPT code 87551.
Billing Code Overview
CPT code 87551 reports a laboratory test that detects the presence of Mycobacterium species using an amplified nucleic acid probe technique. Mycobacteria are acid-fast bacteria that require specialized methods to identify nucleic acid targets in clinical specimens.
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Service type: Molecular diagnostic amplified probe test for Mycobacterium species
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Typical site of service: Clinical laboratory or hospital laboratory performing molecular microbiology testing
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an outpatient infectious disease clinic or hospital pulmonary service with symptoms of persistent cough, night sweats, weight loss, hemoptysis, or unexplained fevers and radiographic findings suspicious for pulmonary tuberculosis or other mycobacterial infection. A sputum sample or bronchoalveolar lavage specimen is collected and sent to the microbiology laboratory. The lab performs an amplified nucleic acid probe assay to detect Mycobacterium species directly from the specimen. Results are reported to the ordering clinician to guide infection control decisions, initiation or modification of anti-mycobacterial therapy, and public health reporting. Typical site of service includes hospital inpatient laboratory, outpatient hospital laboratory, reference laboratory, and clinical microbiology laboratories associated with public health departments. The service is laboratory-based and performed by trained clinical laboratory technologists or molecular diagnostics specialists under appropriate biosafety conditions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the professional interpretation component if applicable in split billing arrangements for molecular test interpretation by pathologist or laboratorian. |
59 |