Need help choosing the right code?
Ask CasePilot about procedures, modifiers, bundling, and coding guidance.
Try CasePilot© Copyright 2026 American Medical Association. All rights reserved.
The CPT® Code 87497 refers to a laboratory test specifically designed for the detection and quantification of the infectious agent cytomegalovirus (CMV) through nucleic acid analysis, which can involve either DNA or RNA. Cytomegalovirus is a member of the herpesvirus family and is known for its ability to be transmitted from person to person via various infected body fluids, including 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 who are immunocompromised. In neonates, congenital or perinatal CMV infection can lead to severe health issues if symptoms are present at birth, or it may result in long-term complications such as hearing loss or vision impairment that may not become apparent until later in life. 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 testing process involves a direct probe test, identified by CPT® Code 87495, which detects the unique nucleic acid sequence of CMV if it exists in the sample. This is achieved by using a probe that is labeled with fluorescent or chemiluminescent markers. The sample undergoes treatment to release nucleic acids from the target organism, allowing the labeled probe to specifically bind to the matching target sequence, forming a stable hybrid. Ribosomal RNA is often the focus of these tests due to its abundance in microorganisms, as opposed to the limited copies found in genomic DNA. The amplified probe technique, denoted by CPT® Code 87496, enhances the sensitivity of the assay by exponentially multiplying the target sequence of CMV DNA or RNA into millions of copies. The most prevalent amplification methods include polymerase chain reaction (PCR) and reverse transcriptase polymerase chain reaction (RT-PCR). Finally, the nucleic acid detection with quantification, represented by CPT® Code 87497, provides a measurement of the quantity of microorganisms present in the sample, often utilizing quantitative or real-time PCR to amplify the isolated nucleic acid segment and generate a detailed report documenting the absolute or relative amounts of the known nucleic acid sequence at each stage of the testing process.
© Copyright 2026 Coding Ahead. All rights reserved.
The procedure associated with CPT® Code 87497 is indicated for the detection and quantification of cytomegalovirus (CMV) in various clinical scenarios. The following conditions and situations warrant the use of this test:
The procedure for CPT® Code 87497 involves several critical steps to ensure accurate detection and quantification of cytomegalovirus (CMV) nucleic acids. The following outlines the procedural steps:
After the completion of the procedure associated with CPT® Code 87497, the following post-procedure considerations are important:
Patients may be advised to follow up with their healthcare provider to discuss the results of the test. Depending on the findings, further diagnostic testing or treatment may be necessary, especially for those with elevated levels of CMV. In cases where CMV infection is confirmed or suspected, appropriate antiviral therapy may be initiated to manage the infection, particularly in immunocompromised individuals or affected neonates. Additionally, ongoing monitoring may be required to assess the effectiveness of treatment and to ensure that viral loads are adequately controlled. It is also essential for healthcare providers to educate patients about the implications of the test results, including potential risks of transmission and the importance of follow-up care.
| Short Descr | CYTOMEG DNA QUANT | Medium Descr | IADNA CYTOMEGALOVIRUS QUANTIFICATION | Long Descr | Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus, quantification | 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 | 2 | 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. | 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. | 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. | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | 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. | GZ | Item or service expected to be denied as not reasonable and necessary | 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. | GA | Waiver of liability statement issued as required by payer policy, individual case | GW | Service not related to the hospice patient's terminal condition | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | PN | Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2011-01-01 | Changed | Short description changed. |
| 1998-01-01 | Added | First appearance in code book in 1998. |
Get instant expert-level medical coding assistance.