CPT code 87150 – Culture typing by nucleic acid amplified probe

Key takeaways

CPT code 87150 covers culture typing by amplified nucleic acid probe, billed per culture or isolate for each organism probed.

An organism must grow in culture before the probe step, or the test is direct molecular detection and 87150 does not apply.

87150 differs from 87149 (direct, non-amplified probe) and 87153 (nucleic acid sequencing), so the code must match the method in the lab report.

Multiple units fit only when distinct organisms are each probed and documented separately, subject to NCCI edit review.

Pabau’s claims management software validates each claim and checks eligibility through Claim.MD, so unit and diagnosis errors surface before the payer sees them.

CPT code 87150: Official descriptor and procedure overview

The American Medical Association publishes the official descriptor for CPT code 87150:

Culture, typing; identification by nucleic acid (DNA or RNA), probe, amplified probe technique, per culture or isolate, each organism probed.

In plain terms, a lab reports 87150 when an organism has grown in culture and an amplified DNA or RNA probe then identifies it. Each part of the descriptor shapes how the code is billed.

• Culture, typing: The code belongs to the microbiology culture typing family. An organism must first grow in culture before this code applies.
• Nucleic acid probe, amplified technique: Identification uses a DNA or RNA probe with signal or target amplification (PCR-based or equivalent). A direct probe with no amplification step is a separate code, 87149.
• Per culture or isolate, each organism probed: The billing unit is the isolate-organism pair. One isolate probed for one organism equals one unit.

Three related services sit outside 87150:

• Direct-from-specimen molecular detection, which has its own code family, typically in the 87470-87660 range.
• Direct (non-amplified) probe identification of an isolate, which is reported with 87149.
• Identification by nucleic acid sequencing, such as 16S rRNA gene sequencing, which is reported with 87153.

How the procedure works: Technique, specimen, and clinical workflow

The workflow behind 87150 runs in two stages, in a fixed order. The culture grows first, and the probe identifies the isolate second. A lab that skips or reverses a stage cannot claim 87150.

1. Specimen collection and culture setup: A clinical specimen, such as a wound swab, respiratory sample, blood culture or urine, is inoculated onto growth media. It is incubated until an isolate grows.
2. Isolate harvesting: A distinct colony or isolate is selected from the culture plate. The culture result is documented in the medical record, confirming growth.
3. Amplified probe application: An amplified nucleic acid probe (PCR-based or equivalent signal amplification) is applied to the isolate to identify the specific organism. The method used must be noted in the lab report.
4. Result reporting: The identified organism is reported to the ordering provider, along with the method. This methodology note is the supporting documentation for 87150 billing.

Document the culture growth step separately from the probe step. A lab that goes straight from specimen to molecular probe is running a direct detection test, so 87150 does not apply.

CPT 87149 vs 87150 vs 87153: Choosing the correct code

Three culture typing codes identify an organism from an isolate with a nucleic acid method, and they differ mainly by technique. 87149 covers a direct probe, 87150 an amplified probe, and 87153 sequencing. Billing 87150 when 87153 applies, or the reverse, is upcoding or downcoding and exposes the claim to denial and audit.

The lab report must name the method explicitly. A report that says “amplified probe technique” supports 87150, and one that says “direct probe” supports 87149. A report that says “16S rRNA sequencing” supports 87153. “Molecular identification” alone names no method, so it puts any of these codes at risk of denial.

The chart below turns that check into two questions you can answer from the lab report.

Billing units: How many times can you bill CPT code 87150 per encounter?

One unit of 87150 equals one organism identified from one isolate with the amplified probe technique. That rule comes straight from the descriptor’s “per culture or isolate, each organism probed” wording, which you can check in the AAPC code reference.

Multiple units in one encounter fit only when distinct organisms are each identified from isolates with this method. Two organisms identified means two units of 87150, provided the lab documents each organism probed separately.

National Correct Coding Initiative (NCCI) edits change quarterly. Before billing multiple units or pairing 87150 with panel codes, check the current edit table. Bundling conflicts are a common denial cause for this code family.

Medicare reimbursement rate for CPT code 87150

Medicare pays CPT code 87150 under the Clinical Laboratory Fee Schedule (CLFS), which CMS updates each January. The CLFS applies to independent labs, physician office labs and other entities billing lab services, rather than the Physician Fee Schedule. For the current national rate, use the CMS Clinical Laboratory Fee Schedule files.

Since 2018, the CLFS has paid a single national rate per code, with no geographic adjustment. Commercial payers set their own allowed amounts, so confirm each payer’s rate before you quote a patient.

• Rate update frequency: Annually, effective January 1. Never rely on a prior-year figure.
• Commercial payer rates: These vary by contract. Many commercial payers set rates as a percentage of the Medicare CLFS, but that depends on the contract.
• CLIA requirement: Complexity is assigned per test system under CLIA (42 CFR Part 493). Labs need a certificate that covers the complexity of the method they run. Billing without the required CLIA certificate is a compliance violation, even when the code is correct.

Documentation requirements for 87150 claims

An 87150 claim holds up only when the medical record supports both medical necessity and the method used. The record needs five elements.

• Order for culture and identification: A provider order specifying that culture and organism identification were requested.
• Culture result noting isolate growth: Lab documentation confirming that a distinct isolate was grown from the specimen before the probe step.
• Methodology note: The lab report must state that an amplified nucleic acid probe technique was used. “Molecular identification” alone is not sufficient.
• Clinical indication and diagnosis: An ICD-10-CM diagnosis code that establishes medical necessity. The diagnosis should be documented in the ordering provider’s notes, not only on the claim form.
• Ordering provider credentials: The ordering provider must be eligible to order under Medicare and any applicable Local Coverage Determination (LCD).

A shared checklist for every clinician who orders this test keeps all five elements on each claim. Check the methodology note first, because the code choice depends on it.

Payer rules and prior authorization for 87150

Medicare does not universally require prior authorization for CPT code 87150. However, LCDs from Medicare Administrative Contractors (MACs) can add coverage criteria. Before billing, check whether your MAC has an active LCD for culture typing by nucleic acid probe. Then confirm that the patient’s diagnosis meets its covered indications.

Insurance eligibility verification before the order shows whether a payer covers 87150 for the patient’s diagnosis, before the lab runs the test. Commercial prior authorization rules vary by plan. Some plans cover amplified culture typing as a routine lab service without authorization. Others require pre-authorization for high-complexity molecular testing, so check the patient’s plan.

Common denial reasons and how to avoid them

Denials for CPT code 87150 cluster around five root causes. Most are preventable with consistent documentation and correct code selection. A structured denial management workflow starts by matching each returned claim to one of them.

When an 87150 claim is denied, the Claim Adjustment Reason Code (CARC) shows which category the denial falls into. Reviewing common denial codes against the 87150 claim history shows whether the lab keeps missing the methodology note or picking the wrong code. The two fixes differ. One is a documentation process change, and the other is coder education.

Getting the claim right the first time is the most efficient approach. A clean claim for 87150 carries six elements:

• The correct code
• The correct units
• A methodology note
• A culture result
• A covered diagnosis
• A CLIA certificate on file with the payer

ICD-10 codes commonly paired with 87150

Pairing CPT code 87150 with a diagnosis that does not establish medical necessity is one of the most direct routes to a denial. These ICD-10-CM codes are often associated with 87150 claims, across the clinical settings where amplified probe culture typing is ordered.

Practices managing infectious disease and sexual health workups see 87150 most often after positive cultures from wound, respiratory, urine and blood specimens. For carrier screening, confirm LCD coverage first, because covered indications vary more there than in acute infection.

When N39.0 is the diagnosis, ICD-10-CM asks for an additional B95-B97 code to name the infectious agent. Add it once the culture identifies the organism.

How claims management software prevents 87150 denials

An 87150 denial usually starts before the claim is sent. A probe result reaches billing without its method, or a second unit goes out on one combined lab entry. The payer then rejects it weeks later.

Pabau, the practice management platform we build, submits CMS-1500 claims through the Claim.MD clearinghouse to thousands of US payers. Its error-checking claims management scrubs each claim for missing or invalid details before it leaves. Eligibility checks run before the visit, so coverage problems show up while there is still time to act.

Payments settle straight from electronic remittance advice (ERA) files, so a denied 87150 line and its reason code reach your team quickly. You fix the cause once, rather than appealing the same denial every month.

Reduce claim denials with smarter billing workflows

Pabau submits claims through Claim.MD, checks eligibility before the visit and posts ERA payments for US labs and practices billing codes like 87150. See how it fits your workflow.

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Conclusion

Code 87150 from the lab report, never from the order. If the report names an amplified probe on a cultured isolate, bill one unit per organism probed. If it names a direct probe or sequencing, switch to 87149 or 87153.

The trade-off is a little more lab paperwork for far fewer denials. Ask the lab to record the culture step, the method and each organism on separate lines, and the claim can stand up to an audit.

Pabau checks eligibility, validates each claim and posts ERA payments through Claim.MD, so unit and diagnosis errors surface before submission. Book a demo to see how Pabau handles lab billing from order to payment.

Continue your research

Want to understand how the claims submission pipeline works? Claim.MD clearinghouse guide explains how electronic lab claims reach payers and where errors are caught.

Need to track down a denial CARC before you appeal? Electronic remittance advice (ERA) explained covers how to read 835 remittance files and identify denial reason codes.

Billing multiple molecular codes in the same encounter? Medical billing compliance guide covers CCI edit principles and correct coding bundling rules for lab services.

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