Coding Specifications
| Modifier | Description | When to Use |
|---|
26 | Professional component | Use when billing only the professional interpretation component when split technical/professional billing applies. |
| 59 | Distinct procedural service | Use when this test is a distinct service separate from other procedures on the same day (modifier 59 is appended per payer-specific guidance).
| 90 | Reference (outside) laboratory | Use when the test was performed by an outside reference laboratory and billed by the performing lab or when specimen forwarded.
| 91 | Repeat clinical diagnostic laboratory test | Use when the same MRSA amplified probe test is repeated on the same day for verification.
| 91 is listed above; note duplicate usage avoided | |
| TC | Technical component | Use when billing only the technical component (laboratory equipment, reagents, technician time).
| 26 | Professional component | See note above for professional interpretation when applicable.
| 90 | Reference laboratory | See note above for outside lab reporting.
| 91 | Repeat test | See note above.
| 52 | Reduced services | Use when the service performed is partially reduced from the full CPT description.
| 53 | Discontinued procedure | Use if specimen processing was started but the test was discontinued for valid reasons.
| 59 | Distinct procedural service | See note above.
| QK | Medical direction of 2–4 service providers; primary surgeon | Rarely used; may apply in complex surgical pathology contexts where direction affects billing.
| QX | Certifying clinician with modifier QK | Paired with QK where applicable.
| QY | Attesting provider in a limited service arrangement | Use when appropriate per payer policy for laboratory services.
| Taxonomy Code | Specialty | Notes |
|---|
207Q00000X | Infectious Disease Specialist | Oversees clinical decision-making for MRSA testing and antimicrobial therapy. |
| 208000000X | Pathology | Pathologists may oversee molecular laboratory testing and result interpretation.
| 367A00000X | Clinical Laboratory Director | Clinical lab management and director responsibilities for molecular diagnostics.
| 207L00000X | Hospitalist | Orders testing and manages inpatient care based on results.
| 170300000X | General Practice/Family Medicine | May order outpatient MRSA testing for wound infections or surveillance.
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|
A49.02 | Methicillin resistant Staphylococcus aureus infection | Directly indicates MRSA infection; a primary reason to perform molecular MRSA testing. |
| L02.91 | Cutaneous abscess, unspecified | Purulent skin lesions often warrant MRSA testing to guide therapy.
| T81.4XXA | Infection following a procedure, initial encounter | Postoperative wound infections frequently require MRSA testing for targeted treatment.
| J15.211 | Pneumonia due to methicillin resistant Staphylococcus aureus | Respiratory MRSA infections may be investigated with molecular assays when respiratory specimens are obtained.
| Z11.59 | Encounter for screening for other bacterial diseases | MRSA surveillance screening (e.g., nasal swab) is coded here when asymptomatic screening is performed.
| Z20.828 | Contact with and (suspected) exposure to other bacterial communicable diseases | Used when exposure to MRSA is a reason for screening or testing.
| R22.9 | Localized swelling, mass and lump, unspecified | When a wound or swelling prompts culture and MRSA testing as part of the workup.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
87070 | Culture, bacterial, any source, bacterial isolation and presumptive identification | Performed when culture-based identification and susceptibility testing are needed alongside molecular MRSA testing. |
| 87590 | Infectious agent antigen detection by immunoassay technique, multiple-step method; Staphylococcus aureus (e.g., rapid antigen test) | Used in some settings for rapid antigen detection as a complementary or alternative test.
| 87081 | Culture, urine, quantitative colony count | Example of specimen processing code for cultures when concurrent culture workup is required; relates to workflow when cultures are ordered in parallel.
| G0493 | Infectious agent detection by nucleic acid (DNA or RNA); amplified probe technique, per organism | An alternative HCPCS-level code sometimes used by payers for nucleic acid amplification tests; conceptually related to 87641 when billing rules differ.
| 99213 | Office or other outpatient visit for the evaluation and management of an established patient | Represents the clinical visit where ordering and result discussion occur; often precedes or follows laboratory testing.