Summary & Overview
CPT 87564: Mycobacterium tuberculosis Detection with Rifampin Resistance
CPT code 87564 represents a molecular diagnostic assay that detects Mycobacterium tuberculosis and assesses rifampin resistance using an amplified nucleic acid probe technique. This test is clinically significant for rapid identification of TB infection and for guiding treatment decisions when rifampin resistance is a concern, which has implications for public health and antimicrobial stewardship nationwide. Payers commonly involved in coverage and reimbursement for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of the clinical context for use of CPT code 87564, the typical service setting, and the role the assay plays in TB diagnosis and resistance detection. The publication summarizes expected benchmarks and reimbursement considerations, notes pertinent policy or coding updates where available, and clarifies common billing practice elements associated with this laboratory molecular diagnostic service. Content is organized to support coding staff, laboratory administrators, and policy analysts seeking a national-level understanding of the code's clinical purpose, payer landscape, and areas where practice and policy intersect. Data not available in the input includes detailed fee schedules, payer-specific coverage policies, associated taxonomies, and ICD-10 diagnoses.
Billing Code Overview
CPT code 87564 describes a laboratory test that uses an amplified nucleic acid probe technique to detect Mycobacterium tuberculosis, the bacterium that causes tuberculosis (TB), and to identify rifampin resistance. The procedure is a molecular diagnostic assay performed by a laboratory analyst to detect bacterial genetic material and determine resistance to the antibiotic rifampin.
Service type: Molecular diagnostic laboratory test (nucleic acid amplification and probe detection)
Typical site of service: Clinical laboratory or hospital laboratory, including public health laboratory settings where TB testing and antimicrobial resistance detection are performed.
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient presents to an outpatient infectious disease clinic with a two-week history of persistent cough, night sweats, weight loss, and a recent positive chest radiograph showing upper lobe cavitary changes. A sputum specimen is collected and sent to the microbiology laboratory for molecular testing to detect Mycobacterium tuberculosis complex and assess rifampin resistance. The laboratory technologist performs an amplified nucleic acid probe assay that targets MTB nucleic acid and includes detection of the rpoB gene mutation associated with rifampin resistance. Results are reported to the ordering clinician and the public health department when required. Typical workflow steps: specimen collection (sputum or bronchoalveolar lavage), specimen transport to the molecular laboratory, nucleic acid extraction, amplification and probe hybridization, result interpretation, and reporting. Typical site of service is a hospital laboratory, freestanding clinical laboratory, or large outpatient microbiology laboratory performing molecular diagnostic testing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the professional (interpretive) component of the laboratory test if separated from the technical component. |
TC |