CPT 87109 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 11 - Office |
| Common Modifiers | None 90 - Reference Laboratory 91 - Repeat Lab Test |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 87109 |
National average reimbursement for CPT 87109 by major payers:
$15.53
$10.78
$18.92
$22.63
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 87109 | $9.02 | 1447317110 - BAPTIST HEALTH CARE, INC., BAPTIST HOME HEALT CARE AND MEDICAL EQUIPMENT | 590657322 - BAPTIST HEALTH CARE INC | FL | Home Health Agency (251E00000X) |
United | 87109 | $15.39 | 1306865761 - HOSPITAL SERVICE DISTRICT NO. 1 OF CALDWELL PARISH, CITIZENS MEDICAL CENTER | 720862035 - (LA) CITIZENS MEDICAL CENTER | LA | General Acute Care Hospital (282N00000X) |
United | 87109 | $13.85 | 1225450588 - PARISH HOSPITAL SERVICE DISTRICT FOR THE PARISH OF ORLEANS, NEW ORLEANS EAST HOSPITAL | 273335876 | LA | General Acute Care Hospital (282N00000X) |
United | 87109 | $18.28 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 87109 | $18.28 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 87109 | $21.50 | 1619910627 - BRADLEY WEISNER | 562107759 - UROLOGY SPECIALISTS OF THE CAROLINAS, PLLC | NC | Urology Physician (208800000X) |
United | 87109 | $25.79 | 1972517365 - COVENANT MEDICAL CENTER | 822913146 - (TX) COVENANT MEDICAL CENTER | TX | General Acute Care Hospital (282N00000X) |
United | 87109 | $6.46 | 1649223645 - ST DAVIDS HEALTHCARE PARTNERSHIP LP LLP, ROUND ROCK MEDICAL CENTER | 743001674 - (TX) LONE STAR CIRCLE OF CARE | TX | General Acute Care Hospital (282N00000X) |
United | 87109 | $9.23 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 87109 | $15.39 | 1215969787 - TENET HOSPITALS LIMITED, THE HOSPITALS OF PROVIDENCE SIERRA CAMPUS | 954537720 | TX | General Acute Care Hospital (282N00000X) |
United | 87109 | $15.39 | 1144203662 - TOPS SPECIALTY HOSPITAL, LTD., TOPS SURGICAL SPECIALTY HOSPITAL | 760246499 - (TX) TOPS SPECIALTY HOSPITAL LTD | TX | General Acute Care Hospital (282N00000X) |
United | 87109 | $15.39 | 1740273994 - ECTOR COUNTY HOSPITAL DISTRICT, MEDICAL CENTER HOSPITAL | 752302928 | TX | General Acute Care Hospital (282N00000X) |
United | 87109 | $15.39 | 1023065794 - CHCA WOMANS HOSPITAL LP, WOMAN'S HOSPITAL OF TEXAS | 621810381 - (TX) CHCA WOMANS HOSPITAL LP | TX | General Acute Care Hospital (282N00000X) |
United | 87109 | $20.31 | 1255478004 - CHRISTOPHER RAIO | 208243412 - SAMARITAN EMERGENCY MEDICAL SERVICES PC | NY | Emergency Medicine Physician (207P00000X) |
United | 87109 | $23.09 | 1003166612 - MATTHEW LILLEY | 680637976 - BEND MEMORIAL CLINIC, PC | OR | Orthopaedic Surgery Physician (207X00000X) |
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 87109 vs. Other Microbiology Procedures Codes
The CPT 87109 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 87109 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 |
|---|---|---|
| 87101-CPT | Low | Fungal Culture, A Sample Of Skin Hair Nail Blood Urine Stool Or Other Body Fluid Is Treated So That If Mold Or Yeast Spores Are Present They Will Grow (Multiply). |
| 87102-CPT | Low | Fungal Culture, A Sample Of Skin Hair Nail Blood Urine Stool Or Other Body Fluid Is Treated So That If Mold Or Yeast Spores Are Present They Will Grow (Multiply). |
| 87106-CPT | Low | Culture Fungi Definitive Ide, Culture Fungi Definitive Identificationeach Organism Yeast (Use 87106 In Additional To Codes 87101 87102 Or 87103 When Appropriate) |
| 87109-CPT | Low | Mycoplasma Bacterial Culture, This Test Identifies An Infection With Mycoplasma. This Bacteria Causes Infections In The Joints Wounds After Childbirth And In The Urinary Tract Lungs And Airways. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87109. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87109 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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