CPT 87003 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Microbiology Procedures |
| Common Place of Service | 81 - Independent Laboratory 20 - Urgent Care Facility 11 - Office |
| Common Modifiers | None QW - CLIA Waived Tests TC - Technical component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 87003 |
| Medicaid Fee Schedule | View Medicaid rates for 87003 |
National average reimbursement for CPT 87003 by major payers:
$17.18
$12.28
$18.63
$24.54
CPT 87003 vs. Other Microbiology Procedures Codes
The CPT 87003 code is part of the Pathology and Laboratory Procedures services used for Microbiology Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 87003 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 87003-CPT | Low | Control Test For Infection, The Test Is Used To Diagnose An Infection By Injecting A Small Amount Of The Test Sample Into A Small Animal. The Animal Is Observed For Signs Of An Infection For Up To Three Weeks. |
| 87015-CPT | Low | Infection Test Concentration, This Test Method Identifies Bacteria Or Parasites That Are The Cause Of An Infection. The Sample Is Concentrated So That The Infection Organisms Collect Together. |
| 87040-CPT | Low | Blood Test Bacteria Infection, This Test Identifies Early Signs Of A Bacterial Growth And Thus Infection In A Blood Sample. Infections In The Blood (Bacteremia Or Sepsis) Can Cause Serious Illness. |
| 87045-CPT | Low | Stool Test For Bacteria, This Test Is Done To Look For The Presence Of Bacteria Which May Cause A Diarrheal Illness. A Specimen Of Fecal Material Is Submitted And The Types Of Bacteria Which Grow From That Specimen Are Analyzed. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87003. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87003 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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