Find policies, billing codes, payers, states, and providers
CPT 87804: Influenza Antigen Immunoassay, Visual Read
CPT code 87804 denotes a visually read immunoassay to detect influenza antigens from respiratory specimens such as nasal or throat swabs. As a commonly used point-of-care and laboratory test, it supports rapid clinical decision-making for patients presenting with influenza-like illness and factors into national infectious disease surveillance, outpatient care workflows, and laboratory billing volumes. Its use influences test-site resource allocation and payer coverage policies for acute respiratory infection management.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise description of the clinical purpose and settings for 87804, an overview of common comparators and related antigen tests, and the typical payer landscape affecting coverage and claims processing. The publication also covers coding context relevant to clinicians and billing professionals, including bundled service considerations and commonly encountered clinical scenarios where a rapid influenza antigen immunoassay is selected over multiplex or molecular testing.
This summary serves clinicians, laboratory managers, and revenue cycle professionals seeking a national-level briefing on the clinical role and billing context of CPT code 87804, with guidance on what elements to verify for claims submission and payer policy alignment.
Customize your policy alerts
Sign up for cpt 87804 policy alerts
Get alerted when payer policies referencing 87804 are released or updated.
Monitor payer policy activity
Billing Code Overview
CPT code 87804 describes an immunoassay with direct optical (visual) observation performed to detect influenza (flu) in a patient specimen. The test is typically run on throat or nasal swab specimens or nasal washings and yields a qualitative result through visually observed reaction in the assay.
Service Type: Infectious agent antigen detection — point-of-care/clinical laboratory immunoassay (visual read)
Typical Site of Service: Outpatient clinics, urgent care centers, physician offices, and clinical laboratories that process respiratory swab or wash specimens.
National Reimbursement Benchmarks
Across national commercial payers, the BUCA average commercial rate for CPT 87804 sits at $35.50, providing a mid-market reference point. Blue Cross Blue Shield displays the highest dispersion between the 25th and 75th percentiles ($58.40 − $30.20 = $28.20), indicating greater variability in contracted rates. Aetna’s interquartile spread is $40.90 − $13.00 = $27.90, nearly as wide. Cigna and UnitedHealth Group show much tighter distributions: Cigna’s IQR is $20.60 − $8.50 = $12.10, and UnitedHealth Group’s is $16.60 − $14.00 = $2.60, the narrowest among listed payers.
In level comparisons, Blue Cross Blue Shield and Aetna drive most of the top-end variability, while UnitedHealth Group constrains rates more closely around its median. Cigna’s moderate spread suggests limited upside and downside from its central tendency. BUCA’s mean at $35.50 sits between Aetna and Blue Cross Blue Shield means, offering a useful benchmark for average commercial reimbursement on CPT 87804.