Summary & Overview
CPT 87045: Aerobic Bacterial Stool Culture for Salmonella and Shigella
CPT code 87045 represents the laboratory procedure for aerobic bacterial stool culture, specifically targeting the identification of pathogens such as Salmonella and Shigella. This code is widely utilized in clinical settings to diagnose gastrointestinal infections, which are common and significant public health concerns across the United States. The procedure is classified under Pathology and Laboratory Procedures and is most often performed in independent laboratory facilities.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, provide coverage for services billed under CPT code 87045. This publication offers a comprehensive overview of payer coverage, clinical context, and relevant billing practices. Readers will gain insights into the clinical indications for the test, typical sites of service, and associated coding practices. The summary also highlights related codes and modifiers commonly used in laboratory billing, as well as the taxonomies linked to this service. Benchmarks and policy updates are included to inform stakeholders about current trends and requirements in laboratory billing for stool cultures.
This resource is designed to support healthcare professionals, laboratory administrators, and policy analysts in understanding the national landscape for CPT code 87045, including payer coverage, clinical relevance, and coding considerations.
CPT Code Overview
CPT code 87045 is used for laboratory analysis involving an aerobic bacterial stool culture. This procedure is performed to isolate potential pathogens and includes a preliminary examination to determine the presence of Salmonella or Shigella species. The service falls under Pathology and Laboratory Procedures and is typically conducted in an Independent Laboratory setting (Place of Service 81). This test plays a crucial role in diagnosing gastrointestinal infections and guiding appropriate clinical management.
Clinical & Coding Specifications
Clinical Context
A patient presents to their healthcare provider with symptoms such as acute diarrhea, abdominal pain, and possibly fever. The provider suspects a bacterial cause for the gastrointestinal symptoms, such as Salmonella or Shigella infection. A stool sample is collected and sent to an independent laboratory (Place of Service 81) for analysis. The laboratory performs an aerobic bacterial stool culture using CPT code 87045, isolating possible pathogens and conducting a preliminary examination to determine the presence of Salmonella or Shigella species. The results assist the provider in diagnosing and managing the patient's condition.
Coding Specifications
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Modifiers:
- Modifier
26: Used to indicate the professional component of the laboratory service, typically when the interpretation is performed separately from the technical work. - Modifier
90: Used when the laboratory test is performed by a reference (outside) laboratory rather than the provider's own facility.
- Modifier
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Associated Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
291U00000X | Clinical Medical Laboratory |
207ZP0102X | Pathology, Clinical Pathology/Laboratory Medicine |
207Q00000X | Family Medicine Physician |
These taxonomies represent the types of providers and laboratories typically involved in ordering, performing, or interpreting the results of CPT code 87045.
Related Diagnoses
A09: Infectious gastroenteritis and colitis, unspecified- Relevant when the provider suspects an infectious cause for gastrointestinal symptoms, but the specific pathogen is not yet identified.
K52.9: Noninfective gastroenteritis and colitis, unspecified- Used when gastrointestinal symptoms are present but are not thought to be caused by infection.
R19.7: Diarrhea, unspecified- Applied when the primary symptom is diarrhea, and the underlying cause is not yet determined.
A04.9: Bacterial intestinal infection, unspecified- Used when a bacterial cause is suspected for intestinal symptoms, but the specific bacteria is not identified.
K59.1: Functional diarrhea- Used for cases where diarrhea is present but is attributed to functional (non-organic) causes rather than infection.
Each diagnosis code is clinically relevant to CPT code 87045 as they represent scenarios where a stool culture for Salmonella or Shigella may be ordered to assist in diagnosis.
Related CPT Codes
87040: The lab analyst performs a bacterial culture on blood, isolating and presumptively identifying any bacteria that grow on selected aerobic media. This code also includes work for anaerobic culture, when performed. Used when blood cultures are needed, often in cases of suspected systemic infection.87046: Data not available in the input.87070: Data not available in the input.87075: Data not available in the input.87077: Data not available in the input.87081: Data not available in the input.
CPT code 87045 is specific to stool cultures for Salmonella or Shigella. Related codes such as 87040 may be used in the same clinical workflow if blood cultures are indicated, for example, in cases of severe infection or sepsis. The other codes listed may represent additional culture procedures for different specimen types or organisms, but their descriptions are not provided.
National Reimbursement Benchmarks
For CPT code 87045, national mean rates among commercial payers show notable variation. The average rate for BUCA (the composite of major commercial payers) is $9.66, while UnitedHealth Group (UHC) is lower at $8.15 and Cigna is highest at $12.48. Blue Cross Blue Shield (BCBS) and Aetna are close to the BUCA average, at $9.24 and $9.95 respectively. Medicare rates are not available in the input for comparison.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. UnitedHealth Group has the tightest spread at $5.00, while Cigna exhibits the widest range at $7.50. This indicates that Cigna's rates are more variable nationally, whereas UHC's rates are more consistent. The table and chart below present the full breakdown of national benchmarks for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska shows a wide spread in reimbursement rates for CPT code 87045 across commercial payers. The rate spread, calculated as the difference between the 75th and 25th percentiles, is most pronounced for Blue Cross Blue Shield ($11.33) and UnitedHealth Group ($3.17), while Aetna's rates are tightly clustered with no spread ($0.00). Cigna has the lowest overall rates and a moderate spread ($5.00). Compared to national averages, all Alaska payers reimburse at substantially higher levels, with Cigna's mean rate in Alaska nearly matching the national mean for Aetna and BCBS.
The table and chart below present the full breakdown of mean rates and percentile distributions for each payer in Alaska, highlighting the significant regional variation and the relative positions of each payer in the market.
Key Insights for Alaska
- Aetna is the highest paying payer for CPT 87045 in Alaska, with a mean rate of $28.94.
- Cigna is the lowest paying payer, with a mean rate of $10.11.
- All Alaska payer mean rates are significantly higher than their respective national averages, with Cigna showing the largest deviation.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.