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The CPT® Code 87516 refers to a laboratory test specifically designed for the detection of the hepatitis B virus (HBV) through the analysis of nucleic acids, which can be either DNA or RNA. This test employs an amplified probe technique, which enhances the sensitivity and specificity of the detection process. Hepatitis B is a significant public health concern, as chronic infection with this virus can lead to severe liver complications, including cirrhosis and hepatocellular carcinoma, a type of liver cancer. The virus is primarily transmitted through blood and body fluids, making it crucial for individuals at risk, such as those with multiple sexual partners or those who share needles, to undergo regular testing. The procedure involves obtaining a blood sample from the patient, which is then processed to extract serum or plasma for testing. The amplified probe technique utilized in this test involves real-time polymerase chain reaction (RT-PCR), a method that replicates specific strands of HBV DNA or RNA. This replication process allows for the identification of the viral genetic material using DNA probes that are tagged with fluorescent or chemiluminescent markers, ensuring that only the target sequences are detected. The sensitivity of this test is notable, as it can identify HBV nucleic acid even at low viral loads, as minimal as 20 IU/mL (116 copies/mL). The presence of HBV DNA or RNA in the sample indicates active viral replication, which is critical for diagnosing and managing HBV infections. Furthermore, this test can provide valuable prognostic information, especially in cases where hepatitis B surface Antigen (HBsAg) is negative. For more comprehensive assessment, CPT® Code 87517 is utilized for quantifying HBV DNA or RNA, allowing healthcare providers to monitor the viral load, which is essential for evaluating disease progression and the effectiveness of treatment regimens.
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The CPT® Code 87516 is indicated for the detection of the hepatitis B virus (HBV) in patients who may be at risk for infection or who exhibit symptoms associated with hepatitis. The following conditions warrant the use of this test:
The procedure for CPT® Code 87516 involves several critical steps to ensure accurate detection of the hepatitis B virus. The following outlines the procedural steps:
After the procedure associated with CPT® Code 87516, the patient may not require any specific post-procedure care, as the test is minimally invasive. However, it is essential for healthcare providers to communicate the results to the patient promptly. If HBV nucleic acid is detected, further clinical evaluation and management may be necessary, including potential treatment options and monitoring strategies. Patients should be informed about the significance of the results, especially if they indicate active infection or a need for further testing. Additionally, healthcare providers should ensure that appropriate follow-up appointments are scheduled to discuss the results and any necessary interventions.
| Short Descr | HEPATITIS B DNA AMP PROBE | Medium Descr | IADNA HEPATITIS B VIRUS AMPLIFIED PROBE TQ | Long Descr | Infectious agent detection by nucleic acid (DNA or RNA); hepatitis B virus, 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) |
| 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. | 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. | 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. | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | 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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