CPT 87040 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 | • 21 - Inpatient Hospital • 23 - Emergency Room |
| Common Modifiers | • None • 26 - Professional component • 91 - Repeat Lab Test |
| Complexity Level | Low |
National average reimbursement for CPT 87040 by major payers:
$10.13
$7.45
$12.65
$15.67
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 87040 | ||||||
United | 87040 | $8.56 | 1740909704 - CAITLIN POWERS | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Physical Therapist (225100000X) |
United | 87040 | $4.32 | 1417944638 - JAMEEL ARASTU | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Neurology Physician (2084N0400X) |
United | 87040 | $8.56 | 1922104546 - KAREN ROUNDS CLEARY | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Family Nurse Practitioner (363LF0000X) |
United | 87040 | $4.32 | 1669841375 - JULIA BRAMLEY | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Audiologist (231H00000X) |
United | 87040 | $5.26 | 1699025528 - JONATHAN BEAVERS | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Anesthesiologist Assistant (367H00000X) |
United | 87040 | $6.19 | 1497945695 - FARAH KHALIL | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Anatomic Pathology & Clinical Pathology Physician (207ZP0102X) |
United | 87040 | $4.32 | 1942294095 - JOHN SULLIVAN | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | FL | Orthopaedic Surgery Physician (207X00000X) |
United | 87040 | $4.32 | 1962464818 - JOHN ELLIS | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Diagnostic Radiology Physician (2085R0202X) |
United | 87040 | $4.32 | 1306453022 - ALISSA TUCCIARONE | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Medical Physician Assistant (363AM0700X) |
United | 87040 | $4.32 | 1710146733 - LEV GOLDINER | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Neurology Physician (2084N0400X) |
United | 87040 | $11.86 | 1477226835 - MORGAN MURAWSKI | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Pediatric Nurse Practitioner (363LP0200X) |
United | 87040 | $11.86 | 1669466884 - SULTANA RAZIA | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Hematology & Oncology Physician (207RH0003X) |
United | 87040 | $6.19 | 1154353589 - MARTINE EXTERMANN | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Medical Oncology Physician (207RX0202X) |
United | 87040 | $8.56 | 1104098631 - HELEN DOLAN | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Family Nurse Practitioner (363LF0000X) |
United | 87040 | $8.56 | 1134113343 - SHELLY HEARN | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Family Medicine Physician (207Q00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 87040 vs. Other Microbiology Procedures Codes
The CPT 87040 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 87040 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 | Anim Inocul,Sml Anim;W Observ/Dis |
| 87015-CPT | Low | Concent,For Parasites,Ova,Tb,Afb |
| 87040-CPT | Low | Culture Bacterial; Blood Aerobic With Isolation And Presumptive Identification Of Isolates (Includes Anaerobic Culture If Appropriate) (Rvsd 1/1/04) |
| 87045-CPT | Low | Culturre, Bacterial, Definitive; Stool, Aerobic, With Isolation And Preliminary Examination, (Eg, Kia, Lia), Salmonella And Shigella Species |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87040. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87040 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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