CPT® Code 87798 is used to report detection of infectious agents using nucleic acid amplification techniques (NAAT) when a more specific CPT code is not available. This method identifies DNA or RNA from pathogens with high sensitivity and specificity.
This code is reported per organism tested and is commonly used for less common or specialized infectious agents not otherwise classified.
Key Facts About CPT® 87798
- Service type: Laboratory test (molecular diagnostics)
- Test: Nucleic acid detection (DNA/RNA) via amplified probe
- Reporting: Per organism (“each”)
- Method: NAAT (e.g., PCR-based techniques)
- Specimen type: Varies (e.g., blood, swab, urine, tissue)
- Provider type: Laboratories, physicians, and qualified healthcare professionals
Common clinical indications:
- Detection of uncommon or specialized infectious agents
- When no organism-specific CPT code exists
- Evaluation of complex or atypical infections
- Infectious disease workups requiring molecular diagnostics
- Immunocompromised patients with unclear infections
When to Use CPT® 87798
CPT 87798 is appropriate when:
- Performing NAAT testing for an organism without a specific CPT code
- Identifying infectious agents using DNA or RNA amplification
- Reporting each organism tested separately
- Clinical presentation supports advanced molecular testing
Examples:
- Testing for rare viral or bacterial pathogens using PCR
- Molecular detection of atypical infections in immunocompromised patients
- Broad infectious disease panels where some organisms lack specific codes
- Identifying pathogens in complex or unresolved infections
Documentation Requirements
To support CPT 87798 billing, documentation should include:
- Patient identifiers and date of service
- Clinical indication for testing
- Specimen type and source
- Organism(s) tested
- Method used (nucleic acid amplification)
- Test results and date reported
- Ordering provider information
Clear documentation is essential to justify use of a non-specific molecular code and support medical necessity.
Reimbursement and Coding Considerations
- CPT 87798 is reported per organism tested
- Used only when no more specific CPT code exists
- May require additional documentation or justification for payer approval
- Often subject to prior authorization or medical review
- Diagnosis coding should support suspected infectious disease
- Frequently used alongside other molecular or microbiology tests
Always verify payer-specific molecular diagnostics billing guidelines.
How OptiMantra Supports Molecular Testing
OptiMantra’s integrated EMR and practice management system streamlines documentation and billing for CPT 87798:
With OptiMantra, providers can:
- Order advanced molecular tests within the patient chart
- Track multiple organisms and test results in one workflow
- Link lab findings to diagnoses and treatment plans
- Maintain organized laboratory documentation that supports billing compliance and audit preparedness
- Integrate specialty lab workflows into a unified system
By centralizing molecular diagnostics, OptiMantra helps practices improve efficiency, ensure compliance, and optimize reimbursement.
Try OptiMantra for free here!
Disclaimer: CPT® codes are maintained by the American Medical Association. This guide is for informational purposes only and does not replace official coding guidelines or payer policies.
