Wiki 87491,87591,87661

[klapetri@ilovemygyn.com]

EmblemHealth -GHI- effective 7/4/2025
Comprehensive code 87801 (Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique) must be submitted when two or more single test codes 87491, 87591 and 87661 are performed on the same date of service.
United Healthcare Commercial
Single Tests:87491 Chlamydia87591 Gonorrhea87661 Trichomonas vaginalisComprehensive Test:87801 Infectious agent, multiple organisms
implemented policy when billing 87491,87591,87661 they require to only code 87801

NY: Appreciate some feedback

 

[abill_423]

UHC considers this a syndromic panel (See their Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing Policy, Professional and Facility) and they want this billed with one code and not separately reported if this is from a single specimen (example all pathogens being tested from a vaginal swab or a urine specimen). 87801 would be the correct code to bill in this scenario.

 

[crystalkay]

If we test more than one specimen say we test 87491/87591 urine, 87591/87491 throat, vaginal swab 87661 would we be able to bill 3 units of 87801 because there are 3 different samples?

 

[nielynco]

If we test more than one specimen say we test 87491/87591 urine, 87591/87491 throat, vaginal swab 87661 would we be able to bill 3 units of 87801 because there are 3 different samples?

The code 87801 was intended to report that there was a positive or negative result for multiple organisms on one specimen. As you are testing 3 different samples, each will then have its own pos/neg result reported by specimen type. However, you may have to list each specimen separately and add a modifier -59 to the additional testing (which was suggested in coding Q&A published by CPT referring to another lab test).

 

[crystalkay]

UHC will not pay the claim if we bill individual codes with a 59 modifier, they make us use 87801 and other insurance carriers have been bundling into 87801 if we bill all individual.