Summary & Overview
CPT 87803: Clostridium difficile Toxin A Immunoassay, Visual
CPT code 87803 denotes a laboratory immunoassay performed by a lab analyst to detect Clostridium difficile toxin A with direct optical (visual) observation. This qualitative laboratory test is a specific assay used in diagnosing C. difficile–associated disease and infection control efforts. Nationally, accurate identification of C. difficile toxins remains important for appropriate clinical management and public health surveillance; clear coding supports consistent billing and utilization tracking across laboratory settings.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines payer coverage patterns, typical sites of service, and clinical context for use of this assay.
Readers will find: concise benchmarks for how this laboratory service is categorized and billed, a clinical summary explaining when the test is used, and notes on coding context and common modifiers (where provided). The document highlights areas where data is available and clearly marks input gaps. This national-level overview is intended for billing professionals, laboratory managers, and policy analysts seeking a succinct reference for CPT code 87803 and its role in diagnostic workflows for Clostridium difficile toxin A.
Billing Code Overview
CPT code 87803 describes a laboratory immunoassay procedure performed by a lab analyst to detect Clostridium difficile toxin A using direct optical (visual) observation. The test represents the technical component of a qualitative immunoassay designed to identify toxin A in patient specimens.
Service type: Laboratory diagnostic test (immunoassay, qualitative, visual read)
Typical site of service: Clinical laboratory or hospital laboratory
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 68-year-old hospitalized patient with recent broad-spectrum antibiotic exposure develops acute onset watery diarrhea, abdominal cramping, and low-grade fever. The treating physician orders stool testing for Clostridioides difficile toxins to confirm suspected C. difficile infection. A stool specimen is collected in the inpatient ward and sent to the hospital clinical microbiology laboratory. The laboratory technologist performs an immunoassay for C. difficile toxin A using direct optical (visual) observation per CPT 87803. Results (positive or negative for toxin A) are reported to the ordering provider and the infection prevention team to guide isolation precautions and antibiotic management. Typical workflow includes specimen accessioning, preparation, running the immunoassay, visual read of results, documentation in the laboratory information system, and release of the result to the electronic health record. Typical site of service is the hospital clinical laboratory or an independent clinical laboratory receiving outpatient or inpatient specimens.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
TC | Technical component | Use when billing the technical portion only (laboratory performs test but professional interpretation not billed separately). |
| 26 | Professional component | Use if a pathologist or laboratory physician bills for professional interpretation or consultation separate from the technical test.