Summary & Overview
CPT 87650: Streptococcus Group A Direct Nucleic Acid Probe Test
CPT code 87650 represents a molecular diagnostic assay that detects Group A Streptococcus using a direct nucleic acid probe. This code covers a commonly ordered laboratory test for rapid and specific identification of Streptococcus pyogenes, which matters nationally for timely diagnosis, infection control, and appropriate antimicrobial use. The code applies across ambulatory and inpatient settings where clinical specimens are processed in certified laboratories.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an explanation of the clinical context for the test, typical sites of service, and which payers commonly cover or adjudicate claims for this molecular diagnostic service. The publication summarizes billing and coding considerations, common modifiers reported with laboratory services, and how this test fits within laboratory service lines.
The content provides benchmarks for utilization and reimbursement trends where available, notes on payer policy variation, and highlights policy updates relevant to molecular diagnostic coding. Data not available in the input is noted explicitly where applicable. The piece is intended to inform billing staff, laboratory managers, and policy analysts about the clinical purpose and billing landscape of CPT code 87650 at a national level.
Billing Code Overview
CPT code 87650 describes a laboratory test for detection of Streptococcus group A using a direct nucleic acid probe technique. This service is a molecular diagnostic test that identifies Group A Streptococcus genetic material directly from patient specimens.
Service type: Molecular diagnostic laboratory service
Typical site of service: Clinical laboratory or hospital laboratory (specimen collected in outpatient clinics, urgent care, emergency departments, or inpatient settings as clinically indicated)
Clinical & Coding Specifications
Clinical Context
A 7-year-old child presents to a primary care clinic with 24 hours of sore throat, fever, tender anterior cervical lymphadenopathy, and tonsillar exudate. The clinician performs a rapid molecular test for Group A Streptococcus using a direct nucleic acid probe technique to quickly confirm or exclude streptococcal pharyngitis and guide treatment decisions. A throat swab is collected by the clinical staff and sent to the on-site or reference laboratory. The laboratory analyst performs 87650 using the direct nucleic acid probe method, documents specimen adequacy and results in the laboratory information system, and reports a positive or negative result to the ordering provider. Typical workflow includes specimen accessioning, test setup, analysis, result validation by the technologist and, when applicable, release of the report to the ordering provider. Typical site of service is an outpatient clinic, urgent care, or hospital outpatient laboratory that performs molecular infectious disease testing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
TC | Technical component | Use when billing only the laboratory technical component for 87650 (e.g., facility or performing lab without professional interpretation). |