CPT® Code 87651

Official Description

Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, amplified probe technique

Common Language Description

The CPT® Code 87651 refers to a laboratory test designed for the detection of the infectious agent known as Streptococcus, group A (GAS) through the use of nucleic acid amplification techniques. This test specifically targets the DNA or RNA of the bacterium, which is crucial for diagnosing infections caused by GAS. Streptococcus, group A is primarily transmitted through respiratory droplets and direct contact with infected skin lesions, such as those seen in impetigo. Additionally, there have been instances of transmission through contaminated food and water. The clinical manifestations of GAS infections are diverse, commonly presenting as respiratory infections and skin infections, but they can also lead to more severe conditions such as meningitis, osteomyelitis, toxic shock syndrome, and necrotizing fasciitis. The test utilizes an amplified probe technique, which significantly enhances the sensitivity of the assay. This is achieved by exponentially amplifying the target nucleic acid sequence of the GAS, allowing for the detection of even minute quantities of the pathogen. The amplification process typically employs polymerase chain reaction (PCR) or reverse transcriptase polymerase chain reaction (RT-PCR) methods. During the testing process, a sample is treated to release nucleic acids from the target organism, if present. A labeled probe, which is designed to bind specifically to the target sequence, is then introduced. This probe is often labeled with fluorescent or chemiluminescent markers, enabling the identification of the hybrid formed between the probe and the target sequence. The amplified sequences can also be quantified, providing valuable information regarding the load of the microorganism present in the sample, which is essential for assessing the severity of the infection and guiding treatment decisions.

1. Indications

The CPT® Code 87651 is indicated for the detection of Streptococcus, group A (GAS) in various clinical scenarios. The following conditions and symptoms warrant the use of this test:

Respiratory Infections - Patients presenting with symptoms such as sore throat, fever, and difficulty swallowing may be tested for GAS to confirm the presence of the bacterium.
Skin Infections - Individuals with skin lesions, particularly those resembling impetigo, may require testing to identify GAS as the causative agent.
Meningitis - In cases of suspected meningitis, especially in children, testing for GAS can help determine the underlying infectious cause.
Osteomyelitis - Patients with bone infections may be tested for GAS to guide appropriate treatment.
Toxic Shock Syndrome - This life-threatening condition may necessitate rapid identification of GAS to initiate timely intervention.
Necrotizing Fasciitis - In cases of severe soft tissue infections, testing for GAS is critical for diagnosis and management.

2. Procedure

The procedure for CPT® Code 87651 involves several key steps to ensure accurate detection of Streptococcus, group A. The following outlines the procedural steps:

Sample Collection - A specimen is collected from the patient, which may include throat swabs, skin lesions, or other relevant samples depending on the suspected site of infection.
Nucleic Acid Extraction - The collected sample undergoes treatment to release nucleic acids from any present GAS. This step is crucial for isolating the target DNA or RNA from the sample.
Amplification of Target Sequence - The extracted nucleic acids are subjected to an amplification process, typically using polymerase chain reaction (PCR) or reverse transcriptase polymerase chain reaction (RT-PCR). This step exponentially increases the quantity of the target GAS nucleic acid, enhancing the sensitivity of the test.
Probe Hybridization - A labeled probe, designed to specifically bind to the target sequence of GAS, is introduced. The probe is labeled with fluorescent or chemiluminescent markers, allowing for easy detection.
Detection and Analysis - The hybrid formed between the probe and the target sequence is detected, and the results are analyzed to confirm the presence of Streptococcus, group A in the sample.

3. Post-Procedure

After the completion of the procedure associated with CPT® Code 87651, the laboratory will analyze the results and report the findings. The expected recovery time for patients is generally quick, as the test is non-invasive and does not require any special post-procedure care. However, the interpretation of results should be conducted in conjunction with clinical findings and other diagnostic tests. If GAS is detected, appropriate treatment options, such as antibiotics, may be initiated based on the severity of the infection and clinical guidelines. It is essential for healthcare providers to communicate the results to the patient and discuss any necessary follow-up actions or additional testing that may be required.

Short Descr	STREP A DNA AMP PROBE
Medium Descr	IADNA STREPTOCOCCUS GROUP A AMPLIFIED PROBE TQ
Long Descr	Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, 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)	Yes
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.
QW	Clia waived test
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
GV	Attending physician not employed or paid under arrangement by the patient's hospice provider
T8	Right foot, fourth digit
XS	Separate structure, a service that is distinct because it was performed on a separate organ/structure
RT	Right side (used to identify procedures performed on the right side of the body)
T2	Left foot, third digit
T1	Left foot, second digit
GA	Waiver of liability statement issued as required by payer policy, individual case
T5	Right foot, great toe
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.
LT	Left side (used to identify procedures performed on the left side of the body)
Q4	Service for ordering/referring physician qualifies as a service exemption
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
SA	Nurse practitioner rendering service in collaboration with a physician
T6	Right foot, second digit
25	Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59.
56	Preoperative management only: when 1 physician or other qualified health care professional performed the preoperative care and evaluation and another performed the surgical procedure, the preoperative component may be identified by adding modifier 56 to the usual procedure number.
58	Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
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.
93	Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system : synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located away at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction.
95	Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system.
99	Multiple modifiers: under certain circumstances 2 or more modifiers may be necessary to completely delineate a service. in such situations modifier 99 should be added to the basic procedure, and other applicable modifiers may be listed as part of the description of the 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)
CR	Catastrophe/disaster related
CS	Cost-sharing waived for specified covid-19 testing-related services that result in and order for or administration of a covid-19 test and/or used for cost-sharing waived preventive services furnished via telehealth in rural health clinics and federally qualified health centers during the covid-19 public health emergency
F5	Right hand, thumb
FA	Left hand, thumb
GC	This service has been performed in part by a resident under the direction of a teaching physician
GF	Non-physician (e.g. nurse practitioner (np), certified registered nurse anesthetist (crna), certified registered nurse (crn), clinical nurse specialist (cns), physician assistant (pa)) services in a critical access hospital
GX	Notice of liability issued, voluntary under payer policy
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
KX	Requirements specified in the medical policy have been met
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
QE	Prescribed amount of stationary oxygen while at rest is less than 1 liter per minute (lpm)
QJ	Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b)
T3	Left foot, fourth digit
T4	Left foot, fifth digit
T7	Right foot, third digit
T9	Right foot, fifth digit
TA	Left foot, great toe
TC	Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles
U6	Medicaid level of care 6, as defined by each state
U7	Medicaid level of care 7, as defined by each state
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