Summary & Overview
CPT 87070: Bacterial Culture from Non-Urine, Blood, or Stool Specimens
CPT code 87070 represents a bacterial culture performed on clinical specimens from sources other than urine, blood, or stool, with isolation and presumptive identification of bacterial isolates. This laboratory procedure is a cornerstone in the diagnosis and management of infectious diseases, providing critical information for clinicians to guide patient care. Nationally, this code is widely utilized across hospital and independent laboratory settings, reflecting its importance in routine and urgent clinical workflows.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. The publication offers insights into payer coverage, policy updates, and clinical benchmarks relevant to 87070. Readers will gain an understanding of the code's clinical context, typical site of service, and its role in laboratory medicine. The summary also highlights related codes and modifiers commonly associated with bacterial culture procedures, supporting accurate billing and compliance.
This article provides a comprehensive overview of 87070, including its clinical applications, payer landscape, and connections to broader laboratory and microbiology services. Healthcare professionals, laboratory administrators, and policy analysts will find actionable information to support decision-making and operational planning.
CPT Code Overview
CPT code 87070 is used to report a bacterial culture from any source except urine, blood, or stool. This procedure involves the isolation and presumptive identification of bacterial isolates from clinical specimens, supporting the diagnosis and management of infectious diseases. The service falls under Microbiology/Pathology – Laboratory Procedures and is typically performed in a laboratory setting, such as Place of Service 19. This code is essential for clinicians seeking to identify bacterial pathogens from a variety of specimen types, enabling targeted treatment and infection control.
Clinical & Coding Specifications
Clinical Context
A patient presents to a clinic with symptoms such as sore throat, fever, or skin infection. The provider suspects a bacterial infection and collects a specimen from a source other than urine, blood, or stool (e.g., throat swab, wound swab, or skin lesion). The specimen is sent to the laboratory for aerobic bacterial culture using CPT code 87070. The laboratory isolates and presumptively identifies any bacterial organisms present. Results are reported to the provider to guide further clinical management, such as antibiotic selection.
Coding Specifications
-
Modifier
26: Used to indicate the professional component of the laboratory service, typically when a physician or pathologist interprets the results. -
Modifier
59: Used to denote a distinct procedural service, such as when multiple cultures are performed from different sites or when the procedure is separate from other laboratory services.
| Modifier Code | Description |
|---|---|
26 | Professional Component |
59 | Distinct Procedural Service |
- Associated Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
291U00000X | Clinical Medical Laboratory |
207ZP0102X | Pathology, Clinical Pathology/Laboratory Medicine |
207Q00000X | Family Medicine Physician |
Related Diagnoses
-
J02.9Acute pharyngitis, unspecified- Relevant when a throat swab is cultured to identify bacterial pathogens causing pharyngitis.
-
J03.90Acute tonsillitis, unspecified- Used when a tonsillar specimen is cultured to determine the causative organism in tonsillitis.
-
L02.91Cutaneous abscess, unspecified- Applicable when a wound or skin lesion is cultured to identify bacteria responsible for abscess formation.
-
N39.0Urinary tract infection, site not specified- Although
87070excludes urine cultures, this code may be used if a non-urine specimen is cultured in the context of a suspected UTI from another site.
- Although
-
R50.9Fever, unspecified- Used when a culture is performed to investigate the cause of unexplained fever, especially when the source is not urine, blood, or stool.
Related CPT Codes
| CPT Code | Description |
|---|---|
87086 | Culture, bacterial; quantitative, urine |
87088 | Culture, bacterial; with isolation and presumptive identification of isolates, urine |
87186 | Susceptibility studies, antimicrobial agent; microdilution or agar dilution |
87205 | Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types |
-
87086and87088are used for urine cultures and are alternatives to87070when the specimen is urine. -
87186is commonly used together with87070when antimicrobial susceptibility testing is needed for isolated bacteria. -
87205may be performed prior to or alongside87070to provide preliminary information about the specimen, such as Gram stain results.
National Reimbursement Benchmarks
National mean rates for CPT code 87070 show that commercial payers, represented by BUCA, average $9.36, while Medicare rates are not available in the input. Among individual commercial payers, Cigna and Aetna have the highest mean rates at $11.59 and $11.16, respectively, while UnitedHealth Group is lowest at $7.46.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. UnitedHealth Group has the tightest range at $4.00, indicating less variability in rates, while Cigna shows the widest spread at $7.00, reflecting greater rate variability. Blue Cross Blue Shield and Aetna both have moderate dispersion, with ranges of $3.33 and $4.50, respectively.
The table and chart below present the full breakdown of national mean rates and percentile values for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska's reimbursement rates for CPT code 87070 show a wide spread across payers, with Blue Cross Blue Shield exhibiting the largest rate range (75th percentile minus 25th percentile) at $12.00, followed by UnitedHealth Group at $2.25, and Cigna at $5.00. Aetna's rates are tightly clustered, with all percentiles at $28.00, indicating minimal variation. Compared to national averages, all Alaska payers offer substantially higher mean rates, with Aetna and Blue Cross Blue Shield standing out for their elevated reimbursement levels relative to their national benchmarks.
The table and chart below present the full breakdown of mean rates and percentile distributions for each payer in Alaska, highlighting the differences in reimbursement and the spread of rates across the market.
Key Insights for Alaska
- Aetna is the highest paying payer for CPT 87070 in Alaska, with a mean rate of $29.54.
- Cigna is the lowest paying payer, with a mean rate of $9.26, significantly below the other payers.
- All Alaska payer mean rates are substantially higher than their respective national averages, with the largest deviation seen in Aetna and Blue Cross Blue Shield.
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