2025 CPT code 87631
(Valid) Effective Date: N/A Pathology and Laboratory Procedures - Microbiology Procedures Feed
Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (e.g., adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 3-5 targets.
Modifiers 59 and 91 may be applicable.
Medically necessary when the patient presents with signs and symptoms of a respiratory infection and the identification of the pathogen is required for appropriate patient management.
Performed by a laboratory analyst.
In simple words: This test identifies 3 to 5 types of viruses that cause respiratory infections, like colds and the flu. It uses a technique called nucleic acid detection, which looks for the viruses' genetic material (DNA or RNA). The test can also detect multiple subtypes within these types.
The laboratory analyst performs the technical steps to detect three to five types or subtypes of pathogens, such as adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, and rhinovirus, that cause respiratory infections. He uses nucleic acid detection, which includes multiplex reverse transcription when performed, and multiplex amplified probe technique.Nucleic acid probes permit identification of microorganisms based on their DNA or RNA. He may also perform reverse transcription in which a nucleotide sequence is copied from a RNA template during DNA synthesis. The lab analyst also performs multiplex amplification probe techniques, which include polymerase chain reaction (PCR). Although not limited to testing for specific conditions, the lab analyst performs this procedure for detection of three to five types or subtypes of pathogens affecting the respiratory system.
Example 1: A patient presents with flu-like symptoms. A multiplex respiratory panel (87631) is ordered to identify the causative pathogen., A child with bronchiolitis is suspected of having RSV. A multiplex PCR panel including RSV (87631) is ordered to confirm the diagnosis., During a suspected outbreak of respiratory illness, a panel including influenza, adenovirus and other pathogens (87631) is used for diagnostics.
Documentation should include the reason for testing, signs, symptoms, or diagnoses supporting the medical necessity of the test.
- Revenue Code: T1H (LAB TESTS - OTHER (NON-MEDICARE FEE SCHEDULE))
- Specialties:Clinical Pathology, Infectious Disease
- Place of Service:Independent Laboratory, Hospital, Office