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The CPT® Code 87625 pertains to the detection of infectious agents through nucleic acid testing, specifically targeting the Human Papillomavirus (HPV). This code is utilized for identifying HPV types 16 and 18, which are recognized as high-risk oncogenic strains associated with cervical cancer. Additionally, this code encompasses type 45 if it is included in the testing process. HPV is a virus that can invade the skin and mucosal epithelia, leading to both clinical and subclinical infections. There are over 100 known types of HPV, with approximately 40 types affecting the anogenital region. High-risk HPV types, particularly types 16 and 18, are often found in high-grade squamous intraepithelial lesions (HSIL) and invasive cancers, while low-risk types are linked to conditions such as acuminate condylomas and low-grade squamous intraepithelial lesions (LSIL) of the cervix. The detection of HPV through nucleic acid testing has become a standard practice in managing cervical disease in women, allowing for timely diagnosis and intervention. The testing process involves collecting exfoliated cervical cells, which are then treated and analyzed to identify the presence of specific HPV types, thereby aiding in the assessment of cervical health and cancer risk.
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The CPT® Code 87625 is indicated for the detection of specific high-risk types of Human Papillomavirus (HPV) in patients. The following conditions warrant the use of this code:
The procedure for CPT® Code 87625 involves several critical steps to ensure accurate detection of HPV types 16 and 18. The process begins with the collection of exfoliated cervical cells from the patient. This is typically done using a cytobrush, swab, or plastic spatula, which allows for the effective gathering of cells from the cervix. Once collected, the cells are re-suspended in a liquid transport medium to preserve their integrity during transport to the laboratory.
In the laboratory, the cell sample undergoes treatment with sodium hydroxide, which serves to denature the DNA present in the sample. This denaturation is crucial as it prepares the DNA for hybridization. Following this, the sample is hybridized in a solution containing two mixtures of non-isotope single-stranded RNA probes. One of these probes is designed to detect low-risk HPV types, while the other targets high-risk HPV types, including types 16 and 18.
After hybridization, the resulting products are transferred to a microplate that contains antibody-coated wells specifically designed to recognize the HPV DNA/RNA hybrids. An alkaline phosphatase-labeled monoclonal antibody is then added to the wells, which binds to the hybrids. Subsequently, a chemiluminescent substrate is introduced, and the light produced from this reaction is measured using a luminometer. The intensity of the light correlates with the amount of HPV DNA/RNA present in the sample, providing a quantitative result that indicates the presence of HPV types 16 and 18.
After the procedure associated with CPT® Code 87625, patients may not require any specific post-procedure care, as the test involves a non-invasive collection method. However, it is essential for healthcare providers to communicate the results to the patient once they are available. The results will guide further management, which may include additional testing, monitoring, or treatment options based on the presence of high-risk HPV types. Patients should be informed about the significance of the results, especially if high-risk HPV types are detected, as this may necessitate closer follow-up and potential intervention to address any cervical lesions or cancer risk.
| Short Descr | HPV TYPES 16 & 18 ONLY | Medium Descr | IADNA HUMAN PAPILLOMAVIRUS TYPES 16 & 18 ONLY | Long Descr | Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), types 16 and 18 only, includes type 45, if performed | 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 |
| 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. | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main 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 | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GW | Service not related to the hospice patient's terminal condition | 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 | GZ | Item or service expected to be denied as not reasonable and necessary | 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 | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner |
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| 2015-01-01 | Added | Added |
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