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The CPT® Code 87496 refers to a laboratory test designed for the detection of the infectious agent known as cytomegalovirus (CMV) through the analysis of nucleic acids, specifically DNA or RNA. Cytomegalovirus is a member of the herpesvirus family and is commonly transmitted from person to person via infected bodily fluids, which include blood, saliva, urine, semen, and breast milk. While CMV infection is prevalent in the general population, it typically manifests as a disease resembling mononucleosis primarily in individuals with compromised immune systems. In neonates, congenital or perinatal CMV infection can lead to severe health issues if symptomatic at birth, or may result in long-term complications such as hearing loss or vision impairment as the child grows. Furthermore, pregnant women who contract CMV have the potential to transmit the virus to their fetus, which can have serious implications for the infant's health. The test utilizes an amplified probe technique to enhance the sensitivity of the assay, allowing for the exponential multiplication of the target nucleic acid sequence associated with CMV. This method significantly improves the likelihood of detecting the virus in a sample, as it can identify even minute quantities of the viral genetic material. The amplification process is commonly achieved through techniques such as polymerase chain reaction (PCR) or reverse transcriptase polymerase chain reaction (RT-PCR), which replicate the target sequences into millions of copies. Following amplification, labeled DNA probes are employed to specifically identify the replicated sequences, facilitating accurate detection of CMV in clinical specimens.
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The CPT® Code 87496 is indicated for the detection of cytomegalovirus (CMV) in various clinical scenarios, particularly in the following conditions:
The procedure for CPT® Code 87496 involves several critical steps to ensure accurate detection of cytomegalovirus (CMV) nucleic acids in a sample. The first step is the collection of a specimen, which may include blood, saliva, urine, or other bodily fluids known to harbor the virus. Once the sample is obtained, it undergoes a treatment process designed to release the nucleic acids from any CMV present. This is crucial as it prepares the sample for the subsequent amplification phase. Following this, the amplified probe technique is employed, which significantly enhances the sensitivity of the test. In this phase, the target nucleic acid sequence of CMV is exponentially multiplied, often using polymerase chain reaction (PCR) or reverse transcriptase polymerase chain reaction (RT-PCR). These amplification methods allow for the generation of millions of copies of the target sequence, making it easier to detect even low levels of the virus. After amplification, labeled DNA probes are introduced to the sample. These probes are specifically designed to bind to the target CMV nucleic acid sequences, forming stable hybrids. The presence of these hybrids indicates a positive result for CMV. The entire process is carefully monitored to ensure accuracy and reliability in the detection of the virus.
After the completion of the procedure associated with CPT® Code 87496, the laboratory will analyze the results to determine the presence of cytomegalovirus in the sample. Depending on the findings, healthcare providers may need to consider further clinical evaluation or treatment options for the patient, especially in cases where CMV is detected in immunocompromised individuals or newborns. It is essential for healthcare professionals to interpret the results in the context of the patient's clinical history and symptoms. Additionally, follow-up testing may be warranted to monitor the patient's condition or to assess the effectiveness of any initiated treatment. Proper documentation of the results and any subsequent actions taken is crucial for ongoing patient care and management.
| Short Descr | CYTOMEG DNA AMP PROBE | Medium Descr | IADNA CYTOMEGALOVIRUS AMPLIFIED PROBE TQ | Long Descr | Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus, amplified probe technique | Status Code | Statutory Exclusion (from MPFS, may be paid under other methodologies) | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | CLIA Waived (QW) | No | APC Status Indicator | Conditionally packaged laboratory tests | Type of Service (TOS) | 5 - Diagnostic Laboratory | Berenson-Eggers TOS (BETOS) | T1H - Lab tests - other (non-Medicare fee schedule) | MUE | 1 | CCS Clinical Classification | 206 - Microscopic examination (bacterial smear, culture, toxicology) |
| 90 | Reference (outside) laboratory: when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GW | Service not related to the hospice patient's terminal condition | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | GZ | Item or service expected to be denied as not reasonable and necessary | 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 91 | Repeat clinical diagnostic laboratory test: in the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of modifier 91. note: this modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. this modifier may not be used when other code(s) describe a series of test results (eg, glucose tolerance tests, evocative/suppression testing). this modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient. | GA | Waiver of liability statement issued as required by payer policy, individual case | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2011-01-01 | Changed | Short description changed. |
| 1998-01-01 | Added | First appearance in code book in 1998. |
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