2025 CPT code 87158
(Active) Effective Date: N/A Revision Date: N/A Laboratory - Microbiology Procedures Pathology and Laboratory Procedures Feed
Microbiology culture and typing using methods beyond those listed in CPT codes 87140-87153.
Modifiers 59 (distinct procedural service) and 91 (repeat clinical diagnostic laboratory test) may be appropriate. Refer to CPT guidelines and local payer instructions for modifier usage.
The medical necessity is established when additional typing of an already identified microorganism is crucial for appropriate management of the infection or condition. This might be indicated by treatment failure, outbreak investigation, or the need for precise pathogen characterization for research purposes. The physician's order must document the clinical indication for this test.
The clinical responsibility rests with the ordering physician who requests the additional typing of an already identified organism to refine diagnostic and treatment decisions. The clinical laboratory is responsible for the technical performance of the test.
In simple words: The lab tests a previously identified germ (like bacteria) using special techniques to find out its exact type.This is done after the germ has already been grown in the lab and identified as a certain kind of bacteria or germ.
This CPT code reports the performance of an analysis on a previously isolated and identified microorganism (bacteria, fungi, parasite, or virus) to further categorize it, typically to the taxonomic level of type.The analysis uses methods not included in CPT codes 87140-87153.These excluded methods include immunofluorescent methods, gas-liquid or high-pressure liquid chromatography, immunologic methods, direct nucleic acid probe techniques, amplified nucleic acid probe techniques, pulse-field gel electrophoresis, and nucleic acid sequencing.Codes 87140-87158 should be used in addition to definitive identification codes. Molecular diagnostic codes (e.g., 81161, 81200-81408) are not used in conjunction with or instead of codes 87140-87158.Modifier 59 is used for multiple specimens/sites, and modifier 91 for repeat tests on the same day.If procedures are not specified in 87003-87912, and are not listed in the Chemistry (82009-84830) or Immunology (86015-86835) sections, use unlisted microbiology procedure code 87999.
Example 1: A patient presents with a persistent infection after initial antibiotic therapy.A bacterial culture was performed previously, identifying the organism to the species level.Code 87158 is used to further type the bacteria to determine antibiotic resistance patterns., A patient has a fungal infection that is not responding to treatment.The fungus was previously identified to the species level.Code 87158 is used to perform additional testing to identify specific subtypes which may influence treatment choice., A hospital outbreak investigation requires detailed typing of a particular virus to determine the source of the outbreak.Code 87158 is used for advanced typing methods beyond basic identification of the virus.
* Physician's order specifying the need for additional typing of the identified microorganism.* Complete laboratory report with detailed methodology and results.* Documentation showing the organism was previously cultured and identified to genus and species level (supporting codes).* Justification of medical necessity.
** Always consult the most up-to-date CPT codebook and payer guidelines for accurate coding and reimbursement.The specific methodology used in typing should be clearly documented for proper billing.
- Revenue Code: T1H (LAB TESTS - OTHER)
- RVU: Data not available in provided text.Refer to CMS guidelines and local payer information for RVU details.
- Global Days: Not applicable. This is a laboratory test.
- Payment Status: Active
- Modifier TC rule: Not applicable. This code refers to a laboratory test and not a surgical procedure.
- Fee Schedule: Data not available in the provided text.
- Specialties:Microbiology, Infectious Disease, Pathology, Clinical Microbiology
- Place of Service:Laboratory, Hospital (inpatient/outpatient), Physician's office