Summary & Overview
CPT 87075: Bacterial Culture, Excluding Blood Specimens
CPT code 87075 represents the laboratory procedure for culturing bacteria from clinical specimens, excluding blood. This code is a cornerstone in microbiology diagnostics, enabling healthcare providers to identify bacterial pathogens and inform treatment decisions. The procedure is commonly performed in laboratory settings and is vital for managing infections such as pharyngitis, pneumonia, abscesses, urinary tract infections, and other bacterial conditions.
Major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare provide coverage for this service, reflecting its widespread clinical importance. Readers will gain insight into payer coverage policies, relevant modifiers such as 26 and TC, associated taxonomies, and common ICD-10 diagnoses linked to this procedure. The publication also highlights related CPT codes for bacterial culture and identification, offering a comprehensive view of microbiology billing practices.
This summary provides an overview of benchmarks, policy updates, and clinical context for CPT code 87075, supporting laboratory and clinical teams in understanding the role and reimbursement landscape of bacterial culture services.
CPT Code Overview
CPT code 87075 is used to report the laboratory procedure for culturing bacteria, except those found in blood specimens. This service falls under Microbiology Culture and Typing Procedures, which are essential for identifying bacterial pathogens in clinical samples. The typical site of service for this procedure is a laboratory setting, specifically at Place of Service 19. Bacterial cultures play a critical role in guiding appropriate treatment and infection control measures across a wide range of clinical scenarios.
Clinical & Coding Specifications
Clinical Context
A patient presents to a clinic with symptoms suggestive of a bacterial infection, such as sore throat, cough, skin abscess, or urinary discomfort. The provider collects a specimen (e.g., throat swab, wound swab, urine sample) and sends it to the laboratory for bacterial culture. The laboratory performs the procedure described by CPT code 87075 (Culture bacteria, except blood) to identify the presence and type of bacteria in the sample. Results guide further clinical management, including targeted antibiotic therapy. The service is typically performed in a laboratory setting (Place of Service 19).
Coding Specifications
-
Modifiers:
- Modifier
26: Indicates the professional component, used when only the interpretation of the culture is performed by the provider. - Modifier
TC: Indicates the technical component, used when only the technical aspect (e.g., specimen processing, culture setup) is performed.
- Modifier
-
Associated Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
291U00000X | Clinical Medical Laboratory |
207ZP0102X | Pathology |
207Q00000X | Family Medicine Physician |
These taxonomies represent laboratories, pathologists, and family medicine physicians who may be involved in ordering, performing, or interpreting the culture procedure.
Related Diagnoses
-
J02.9Acute pharyngitis, unspecified- Relevant when a throat culture is performed to identify bacterial causes of pharyngitis.
-
J18.9Pneumonia, unspecified organism- Used when a respiratory specimen is cultured to determine bacterial etiology of pneumonia.
-
L02.91Cutaneous abscess, unspecified- Applicable when a wound or skin abscess is cultured to identify causative bacteria.
-
N39.0Urinary tract infection, site not specified- Used when a urine sample is cultured to diagnose bacterial urinary tract infection.
-
A49.9Bacterial infection, unspecified- Used for general bacterial infections when the site or organism is not specified, supporting the need for culture.
Related CPT Codes
| CPT Code | Description | Clinical Relationship |
|---|---|---|
87073 | Culture bacteria anaerobic | Used for culturing anaerobic bacteria; alternative or adjunct to 87075 when anaerobic infection is suspected. |
87076 | Culture anaerobe ident, each | Used to identify specific anaerobic bacteria; may follow 87073 or 87075 if anaerobes are detected. |
87077 | Culture aerobic identify | Used to identify aerobic bacteria; commonly performed after 87075 if aerobic bacteria are present. |
87081 | Culture screen only | Used for screening purposes; may be used as an alternative to 87075 for preliminary assessment. |
These codes are related to 87075 and may be used together or as alternatives depending on the clinical scenario and suspected organisms.
National Reimbursement Benchmarks
For CPT code 87075, the national mean rate for BUCA (the average of major commercial payers) is $9.91, which is higher than the UnitedHealth Group mean rate of $8.25 and Blue Cross Blue Shield at $9.36. Cigna stands out with the highest mean rate at $12.47, while Aetna is also above the BUCA average at $10.80. Medicare rates are not available in the input.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. UnitedHealth Group has the tightest range at $5.00 ($9.00 - $4.00), while Cigna shows the widest spread at $7.50 ($13.00 - $5.50). Blue Cross Blue Shield and BUCA both have moderate dispersion, with ranges of $4.17 and $4.67, respectively. Aetna's range is $4.25.
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 87075 show a wide spread between payers, with the 75th percentile minus the 25th percentile ranging from $3.00 for Aetna to $11.33 for Blue Cross Blue Shield. Cigna displays a narrower spread of $5.00, while UnitedHealth Group's spread is $3.00. This indicates that Blue Cross Blue Shield has the most variability in rates among the major payers in Alaska.
Compared to national averages, all Alaska payers offer substantially higher mean rates for CPT code 87075. The table and chart below present the full breakdown of payer-specific rates, highlighting the differences in reimbursement levels across the state.
Key Insights for Alaska
- Aetna is the highest paying payer for CPT 87075 in Alaska, with a mean rate of $28.79.
- Cigna is the lowest paying payer, with a mean rate of $10.10.
- 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.