Summary & Overview
CPT 87880: Rapid Detection of Group A Streptococcus by Immunoassay
CPT code 87880 is a widely utilized laboratory procedure for the rapid detection of group A Streptococcus using immunoassay with direct optical observation. This test is essential in diagnosing streptococcal pharyngitis and related infections, enabling prompt treatment and reducing unnecessary antibiotic use. The code is most commonly billed in office settings, reflecting its role in point-of-care diagnostics.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, provide coverage for this procedure, underscoring its clinical and billing significance across the United States. Readers will gain insights into payer coverage, relevant modifiers such as QW for CLIA-waived tests and 59 for distinct procedural services, and associated clinical taxonomies. The publication also reviews common ICD-10 diagnoses linked to this code, such as streptococcal pharyngitis and acute tonsillitis, and highlights related CPT codes that may be used in similar clinical scenarios.
This summary offers a comprehensive overview of the clinical context, billing practices, and policy considerations for CPT code 87880, equipping healthcare professionals and administrators with the information needed to understand its national relevance and operational details.
CPT Code Overview
CPT code 87880 is used for the detection of infectious agents by immunoassay with direct optical observation, specifically targeting Streptococcus, group A. This procedure falls under Pathology and Laboratory Procedures – Microbiology Procedures and is commonly performed in an office setting (POS 11). The test is a rapid diagnostic tool that assists clinicians in identifying group A streptococcal infections, which are a frequent cause of pharyngitis and tonsillitis. Its use supports timely clinical decision-making and appropriate patient management.
Clinical & Coding Specifications
Clinical Context
A patient presents to a family medicine or internal medicine office with symptoms such as sore throat, fever, and difficulty swallowing. The clinician suspects a streptococcal infection based on the clinical assessment. A throat swab is collected and a rapid immunoassay test for Group A Streptococcus is performed in the office setting. The test provides direct optical observation results, allowing for immediate diagnosis and management. This workflow is typical for the use of CPT code 87880 in outpatient settings.
Coding Specifications
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Modifier
QW: Indicates that the test is CLIA-waived and can be performed in a non-laboratory setting, such as a physician's office. -
Modifier
59: Used to denote a distinct procedural service, typically when multiple procedures are performed on the same day that are not normally reported together.
| Taxonomy Code | Specialty |
|---|---|
291U00000X | Clinical Medical Laboratory |