Summary & Overview
CPT 87797: Direct Nucleic Acid Probe Test for Infectious Agent
CPT code 87797 represents a laboratory molecular diagnostic test using a direct nucleic acid probe technique to detect an infectious agent not otherwise specified by other CPT codes. It matters nationally because it provides a billing pathway for direct probe-based infectious agent testing when no specific agent code applies, supporting diagnostic flexibility in clinical microbiology and public health surveillance.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise overview of code intent, typical clinical and laboratory contexts, and the payer landscape relevant to claims processing. The publication also outlines common modifiers used with the code, the typical service line for laboratory testing, and guidance on how this code fits within molecular diagnostic billing practices.
This summary provides operational clarity for billing teams and laboratory managers about where 87797 is used, what it represents clinically, and which national payers commonly adjudicate claims for direct probe infectious agent tests. Data not available in the input is noted where applicable in the detailed sections.
Billing Code Overview
CPT code 87797 describes a laboratory procedure in which a lab analyst performs a test for an infectious agent, not otherwise specified in another code, using a direct nucleic acid probe technique on the specimen. This code is used when the laboratory technique is known to be a direct probe method but no specific CPT code exists for the infectious agent tested.
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Service type: Laboratory infectious agent testing using direct nucleic acid probe techniques
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Typical site of service: Clinical laboratories, hospital laboratories, and other certified laboratory settings where molecular diagnostic testing is performed
Clinical & Coding Specifications
Clinical Context
A mid-adult outpatient presents to a hospital-based microbiology laboratory with a respiratory specimen collected after a clinician suspects an atypical infectious etiology not covered by organism-specific molecular tests. The specimen (e.g., nasopharyngeal swab or bronchoalveolar lavage) is received by the laboratory. The laboratory technologist verifies specimen identification and orders a direct nucleic acid probe test because the clinician requested testing using a direct probe technique or because available multiplex PCR panels did not include the suspected pathogen. The lab analyst performs 87797 to detect the presence of an infectious agent using a direct nucleic acid probe. Results are documented in the laboratory information system and reported to the ordering provider. Turnaround time depends on probe availability and batching; results guide targeted antimicrobial therapy or infection control measures. Typical site of service is a hospital laboratory, reference laboratory, or independent clinical laboratory supporting inpatient and outpatient care.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when reporting only the professional interpretation component if separated from the technical component. |