CPT® Code 87807 is used to report infectious agent antigen detection for respiratory syncytial virus (RSV) using an immunoassay technique (e.g., direct optical observation). This test provides rapid identification of RSV infection, supporting timely diagnosis and management, particularly in pediatric and high-risk populations.
This code typically reflects point-of-care or rapid testing, not molecular (PCR) methods, which are reported with different CPT codes.
Key Facts About CPT® 87807
- Service type: Laboratory test (infectious disease, point-of-care)
- Test: RSV antigen detection via immunoassay
- Method: Immunoassay with direct optical observation
- Specimen type: Nasal or nasopharyngeal swab
- Test purpose: Rapid detection of RSV infection
- Provider type: Physicians, laboratories, and qualified healthcare professionals
Common clinical indications:
- Suspected RSV infection
- Acute respiratory symptoms (e.g., cough, wheezing, fever)
- Pediatric respiratory illness
- Evaluation of infants, elderly, or immunocompromised patients
- Seasonal respiratory infection screening
When to Use CPT® 87807
CPT 87807 is appropriate when:
- Performing rapid RSV antigen detection using an immunoassay
- Evaluating patients with acute respiratory symptoms
- Immediate results are needed for clinical decision-making
- The test is not performed using molecular (PCR) methods
Examples:
- Testing an infant with bronchiolitis symptoms during RSV season
- Rapid RSV screening in urgent care or pediatric clinic
- Evaluating respiratory illness in high-risk populations
- Differentiating RSV from other viral respiratory infections
Documentation Requirements
To support CPT 87807 billing, documentation should include:
- Patient identifiers and date of service
- Clinical indication for RSV testing
- Specimen source (e.g., nasal swab)
- Test performed (RSV antigen detection via immunoassay)
- Test result and time performed
- Ordering or supervising provider information
Clear documentation supports medical necessity and accurate billing for point-of-care testing.
Reimbursement and Coding Considerations
- CPT 87807 is generally covered when medically necessary
- Must reflect immunoassay methodology (not PCR or molecular testing)
- May be subject to CLIA waiver requirements depending on the setting
- Often used in outpatient, urgent care, and pediatric settings
- Frequency and coverage may vary by payer
Always verify payer-specific infectious disease testing and CLIA requirements.
How OptiMantra Supports Respiratory Testing
OptiMantra’s integrated EMR and practice management platform streamlines documentation and billing for CPT 87807:
With OptiMantra, providers can:
- Document point-of-care RSV testing directly within the patient chart
- Capture real-time test results during patient visits
- Link results to diagnoses and treatment plans
- Maintain organized laboratory documentation that supports billing compliance and audit preparedness
- Integrate respiratory testing workflows into a single system
By centralizing diagnostic workflows, OptiMantra helps practices improve efficiency, ensure compliance, and optimize reimbursement.
Try OptiMantra for free here!
Disclaimer: CPT® codes are maintained by the American Medical Association. This guide is for informational purposes only and does not replace official coding guidelines or payer policies.
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