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CPT 87880: Rapid Streptococcus Group A Antigen Immunoassay
CPT code 87880 denotes a rapid immunoassay with direct optical (visual) observation to detect Streptococcus, group A, typically performed on throat swab specimens. This point-of-care test provides clinicians with fast antigen detection results that can influence immediate management of pharyngitis and reduce unnecessary antibiotic use. Nationally, rapid strep testing remains a common ambulatory laboratory service with implications for outpatient clinical workflows and laboratory billing practices.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines payer coverage considerations, common related procedure codes, and clinical contexts for use, including typical ICD-10 diagnoses associated with the service such as streptococcal pharyngitis and acute pharyngitis.
Readers will find: a concise explanation of what CPT code 87880 represents and where it is typically performed; comparisons to related codes used for Streptococcus testing; commonly encountered billing modifiers and service line considerations; and coding contexts linked to relevant throat infection diagnoses. The content is designed for billing professionals, clinicians, and policy analysts seeking a clear, national-level reference for the clinical and billing profile of rapid group A strep antigen tests.
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Billing Code Overview
CPT code 87880 describes an immunoassay with direct optical (visual) observation used to detect Streptococcus, group A in a patient specimen, most commonly a throat swab. The test identifies group A streptococcal antigen by visually reading a lateral flow or similar rapid immunoassay device.
Service type: Point-of-care rapid antigen detection test.
Typical site of service: Outpatient clinic, urgent care, physician office, or other ambulatory settings where throat swabs are collected and rapid results are needed.
National Reimbursement Benchmarks
Across national commercial payers, BUCA’s average commercial rate of $27 serves as a mid-market reference point while individual payer means vary: Aetna $22.4, Blue Cross Blue Shield $33.6, Cigna $15.9, and UnitedHealth Group $16.1. Blue Cross Blue Shield shows the highest mean and widest absolute spread in upper-to-lower quartiles, indicating broader negotiated outcomes around that higher central tendency. Cigna and UnitedHealth Group sit below BUCA’s mean, with Cigna’s lower quartile concentration suggesting more skew toward modest rates.
Comparing dispersion (P75 minus P25) highlights which payers are tightest or widest: Aetna’s interquartile spread is $15.0, Blue Cross Blue Shield’s is $13.7, BUCA’s is $12.5, Cigna’s is $12.5, and UnitedHealth Group’s is $6.0, making UnitedHealth Group the tightest and Aetna the widest by this measure. Maximums and minimums where available further underline that Blue Cross Blue Shield reaches the highest ceiling ($108.8) while Aetna and Cigna show lower floor points ($4.2 and $5.0 respectively).