2025 CPT code 87999
(Active) Effective Date: N/A Pathology and Laboratory - Microbiology Procedures Pathology and Laboratory Feed
Unlisted microbiology procedure.
Modifiers may be applicable. Modifier 59 is used for distinct procedural services and modifier 91 for repeat tests on the same day.
Medical necessity must be established by demonstrating why the unlisted procedure was necessary when no specific code exists. Clear documentation explaining the clinical rationale and the unique circumstances requiring this test is essential.
Performed by a laboratory analyst when no specific CPT code exists for the performed microbiology procedure.
In simple words: This code is used when a lab test involving the study of microorganisms (like bacteria, fungi, or viruses) is done, but there isn't a specific code for that exact test.
This code is used for microbiology procedures that are not described by other CPT codes. This includes procedures involving bacteriology, mycology, parasitology, and virology, and may involve presumptive or definitive identification of microorganisms.If specific codes exist for molecular probes, nucleic acid sequencing, chromatography, or immunologic techniques (87140-87158, 81161, 81200-81408), those should be used instead.
Example 1: A patient has a wound infection, and the culture reveals an unusual organism not identifiable by standard methods. Further testing using a novel technique is required, and because there's no specific code for this new technique, 87999 is used., A research laboratory performs an experimental microbiology procedure to identify a newly discovered pathogen. Since this procedure is not yet recognized by existing CPT codes, 87999 is reported., A physician orders a susceptibility test for an unusual mycobacterial species not included in the standard panels. As no specific susceptibility code exists for this specific organism, the lab uses 87999 for the custom test.
Detailed documentation of the procedure performed, including the method used, the organism(s) involved, and the results obtained. It's crucial to explain why existing codes are not applicable and provide supporting documentation such as operative notes. A comparison to similar, existing codes can help justify the billed amount.
** When using 87999, it is crucial to provide thorough documentation to justify its use. This includes a detailed description of the procedure, an explanation of why a more specific code is not applicable, and comparison to similar procedures with established codes. Providing supporting clinical documentation and operative notes helps strengthen the claim and minimize the risk of denial.Contacting the payer for pre-authorization or clarification on billing procedures is highly recommended when using this unlisted code.
- Revenue Code: T1H - LAB TESTS - OTHER (NON-MEDICARE FEE SCHEDULE)
- Payment Status: Active
- Specialties:Microbiology, Infectious Disease, Pathology
- Place of Service:Independent Laboratory, Hospital Laboratory