Summary & Overview
CPT 87552: Mycobacterium Nucleic Acid Probe Test
CPT code 87552 is a laboratory molecular diagnostic code for a nucleic acid probe test that detects and quantifies infection by Mycobacterium species. This code represents a targeted molecular assay used to confirm acid-fast bacterial infections, which has implications for infectious disease diagnosis, public health surveillance, and antimicrobial management. Nationally, accurate billing and coding for mycobacterial molecular testing supports appropriate laboratory reimbursement and epidemiologic tracking.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context for when a nucleic acid probe test for Mycobacterium is performed, typical sites of service, and the role of this assay in confirmatory laboratory diagnosis. The publication outlines billing benchmarks, common payer coverage considerations, and policy-relevant issues affecting molecular mycobacterial testing. It also summarizes typical use cases in clinical microbiology and laboratory workflow implications.
This summary provides a concise guide to the clinical purpose of CPT code 87552, the payer landscape addressed, and the practical information readers need to understand coding and use of nucleic acid probe testing for Mycobacterium species in routine laboratory practice.
Billing Code Overview
CPT code 87552 describes a laboratory assay that uses a nucleic acid probe technique to detect and quantify infection with Mycobacterium species. The test identifies acid-fast bacteria using molecular probes aimed at mycobacterial nucleic acids and provides laboratory confirmation of mycobacterial infection.
Service Type: Laboratory diagnostic test — molecular nucleic acid probe
Typical Site of Service: Clinical laboratory or hospital laboratory
Clinical & Coding Specifications
Clinical Context
A 42-year-old patient presents to an outpatient infectious disease clinic with a two-week history of persistent cough, night sweats, weight loss, and intermittent low-grade fevers. The clinician obtains a sputum specimen after appropriate collection technique and orders a nucleic acid probe test to detect Mycobacterium species. The specimen is sent to the clinical microbiology laboratory where a medical technologist or lab analyst performs the nucleic acid probe assay to identify and quantify Mycobacterium organisms (acid-fast bacteria). Results are reported to the ordering clinician and entered in the laboratory information system; positive identification prompts initiation or adjustment of anti-mycobacterial therapy and public health notification as indicated. Typical workflow steps include specimen receipt and accessioning, sample preparation, probe hybridization and detection, quality controls, interpretation, and result reporting. Typical site of service is an outpatient clinic or hospital laboratory performing microbiology testing; the service type is laboratory diagnostic testing using molecular nucleic acid probe technique.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the professional component for interpretation if separated from technical component |
59 |