Summary & Overview
CPT 87555: Mycobacterium tuberculosis Direct Nucleic Acid Probe Test
CPT code 87555 denotes a laboratory molecular assay that uses a direct nucleic acid probe to detect Mycobacterium tuberculosis. This diagnostic technique targets bacterial nucleic acid to rapidly identify tuberculosis infection in clinical specimens and plays a central role in timely diagnosis and infection control. Nationally, molecular diagnostics for tuberculosis remain important for public health surveillance, expedited treatment decisions, and laboratory workflow efficiency.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage and payment policies for molecular tuberculosis testing vary by payer and by clinical context, affecting site-of-service utilization between hospital and reference laboratories.
Readers will find an overview of clinical context for the assay, typical sites of service, common billing modifiers provided in the input, and an outline of what to expect in payer policy and reimbursement environments. The publication summarizes benchmarking and policy considerations relevant to laboratory managers, billing professionals, and clinicians engaged in tuberculosis diagnostics. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 87555 describes a laboratory test that detects Mycobacterium tuberculosis using a direct nucleic acid probe technique. The procedure identifies genetic material specific to the bacterium, which is sometimes referred to as an acid-fast organism due to the specialized staining used in microscopy.
Service type: Laboratory diagnostic test — molecular assay (direct nucleic acid probe)
Typical site of service: Clinical laboratory or hospital laboratory
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an outpatient infectious disease clinic or hospital pulmonary service with signs or symptoms suggestive of active pulmonary tuberculosis (persistent cough >2–3 weeks, hemoptysis, night sweats, weight loss, fever) or with a positive screening test requiring confirmatory testing. Sputum, bronchoalveolar lavage, or other respiratory specimens are collected at the point of care by nursing or respiratory therapy and sent to the clinical microbiology laboratory. In the laboratory, a trained technologist or lab analyst performs a direct nucleic acid probe test to detect Mycobacterium tuberculosis complex nucleic acid sequences in the specimen. Results are reported to the ordering clinician and infection control; a positive result accelerates initiation of airborne isolation procedures and anti-tuberculous therapy, while a negative result leads to further culture-based testing and clinical correlation. Billing is generated under 87555 for the laboratory analytic procedure; professional interpretation and reporting by a pathologist or laboratory director may be billed with appropriate modifiers when applicable.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the professional component (interpretation) performed by a pathologist or laboratory physician separate from the technical test. |