2025 CPT code 87451
(Current) Effective Date: N/A Revision Date: N/A Pathology and Laboratory Procedures - Microbiology Procedures Pathology and Laboratory Feed
Infectious agent antigen detection by immunoassay technique (e.g., EIA, ELISA, FIA, IMCA), qualitative or semiquantitative; polyvalent for multiple organisms, each polyvalent antiserum.
Modifiers 59 and 91 can be used with this code.
Medical necessity for 87451 is established by the patient's clinical presentation, signs, and symptoms suggestive of an infectious process requiring the identification of multiple potential pathogens.Documentation should link the test to the patient's condition and justify the need for a multiplex assay.
The laboratory professional performs the immunoassay test using appropriate techniques on a primary source specimen. They analyze the results and report the presence or absence, or the approximate quantity of the detected antigens.
In simple words: This test helps identify infections by detecting specific proteins (antigens) from multiple germs (like viruses, bacteria, fungi, or parasites) in a sample like blood or stool, using techniques like EIA and ELISA.This is helpful for diagnosing active infections, especially when a person is acutely ill.
This code represents the laboratory test for detecting antigens of multiple infectious organisms using various immunoassay techniques, including enzyme immunoassay (EIA), enzyme-linked immunosorbent assay (ELISA), fluorescence immunoassay (FIA), and immunochemiluminometric assay (IMCA).The test is qualitative or semiquantitative, meaning it either detects the presence/absence of the antigen or provides an approximate quantity.The term "polyvalent for multiple organisms" indicates that the test can detect multiple organisms within a single assay, and each polyvalent antiserum is used for a specific group of organisms. This code is used for primary source specimens.
Example 1: A patient presents with acute diarrhea. To identify the causative organism(s), a stool sample is collected and tested using 87451 to detect antigens from multiple bacterial, viral, and parasitic pathogens commonly associated with diarrhea., A patient with suspected sepsis has blood drawn. Code 87451 is used for a rapid immunoassay panel that detects antigens from various bacteria and fungi that can cause sepsis., A patient with flu-like symptoms has a nasal swab collected. 87451 is used for a multiplex respiratory panel detecting antigens from common respiratory viruses like influenza A and B, respiratory syncytial virus (RSV), and others.
The physician's order for the test should include the suspected diagnosis or clinical indication.The laboratory report should document the specimen source, the specific immunoassay method used, the organisms tested for, and the qualitative or semiquantitative results.The medical record should contain the patient's history, physical exam findings, and other relevant diagnostic information supporting the medical necessity of the test. For multiple specimens/sites, modifier 59 should be documented. For repeat laboratory tests on the same day, modifier 91 should be documented.
- Revenue Code: T1H (LAB TESTS - OTHER (NON-MEDICARE FEE SCHEDULE))
- Payment Status: Active
- Specialties:Infectious Disease, Internal Medicine, Family Medicine, Pediatrics, Emergency Medicine, Pathology
- Place of Service:Office, Independent Clinic, Inpatient Hospital, Outpatient Hospital, Emergency Room - Hospital,Federally Qualified Health Center, Public Health Clinic, Rural Health Clinic, Independent Laboratory,Military Treatment Facility