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The CPT® Code 87506 refers to the detection of infectious agents through nucleic acid analysis, specifically targeting gastrointestinal pathogens. These pathogens are known to cause diarrheal diseases, which are particularly concerning as they are the leading cause of malnutrition in children under five years of age and the second leading cause of mortality in this demographic. The procedure involves the simultaneous qualitative detection of various pathogenic viruses, bacteria, and parasites from fecal specimens collected from patients exhibiting signs and symptoms indicative of infectious colitis or gastroenteritis. During the testing process, the fecal sample is introduced into a culture medium where the nucleic acids, both DNA and RNA, of the pathogens are amplified using techniques such as polymerase chain reaction (PCR) or reverse transcription. Advanced technologies, such as the Luminex xTAG system, are employed to analyze the sample, allowing for the detection of the presence or absence of each targeted pathogen. The pathogens identified through this code include various types and subtypes of Clostridium difficile, Escherichia coli, Campylobacter, Salmonella, Shigella, norovirus, Rotavirus, Giardia, and Cryptosporidium. It is important to note that this specific code, 87506, is designated for panels that test for 6 to 11 pathogenic targets, distinguishing it from other related codes that cover different ranges of targets.
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The CPT® Code 87506 is indicated for use in patients who present with signs and symptoms of infectious colitis or gastroenteritis. The following conditions may warrant the use of this code:
The procedure associated with CPT® Code 87506 involves several critical steps to ensure accurate detection of gastrointestinal pathogens. The following procedural steps are outlined:
After the completion of the procedure associated with CPT® Code 87506, the results of the pathogen detection are typically reviewed and interpreted by a qualified healthcare professional. The findings can guide further clinical management and treatment decisions for the patient. It is essential to communicate the results to the patient and consider any necessary follow-up actions based on the identified pathogens. Additionally, proper documentation of the procedure and results is crucial for compliance and billing purposes.
| Short Descr | IADNA-DNA/RNA PROBE TQ 6-11 | Medium Descr | IADNA-DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6-11 | Long Descr | Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen (eg, Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 6-11 targets | 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 |
| 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. | GZ | Item or service expected to be denied as not reasonable and necessary | GA | Waiver of liability statement issued as required by payer policy, individual case | 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. | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | GW | Service not related to the hospice patient's terminal condition | 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. | 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. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | 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 | Q4 | Service for ordering/referring physician qualifies as a service exemption | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2015-01-01 | Added | Added |
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