CPT 87116 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 • 81 - Independent Laboratory |
| Common Modifiers | • None • 26 - Professional component • 91 - Repeat Lab Test |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 87116 |
National average reimbursement for CPT 87116 by major payers:
$10.70
$7.49
$12.51
$16.25
| 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 87116 | ||||||
United | 87116 | $6.34 | 1801893417 - SMITHVILLE HOSPITAL AUTHORITY, SMITHVILLE REGIONAL HOSPITAL | 741706734 | TX | General Acute Care Hospital (282N00000X) |
United | 87116 | $10.80 | 1861994808 - HCN EP HORIZON CITY, LLC, THE HOSPITALS OF PROVIDENCE NORTHEAST CAMPUS | 813935393 - (TX) HCN EP HORIZON CITY LLC | TX | General Acute Care Hospital (282N00000X) |
United | 87116 | $5.59 | 1255728119 - CHANA VAN HOUTEN | 464454536 - (TX) NADIR MIR ALI MD PLLC | TX | General Acute Care Hospital (282N00000X) |
United | 87116 | $10.80 | 1063466035 - CHCA CLEAR LAKE LP, HCA HOUSTON HEALTHCARE CLEAR LAKE | 621801360 | TX | General Acute Care Hospital (282N00000X) |
United | 87116 | $9.72 | 1104057694 - SPECIALISTS HOSPITAL SHREVEPORT, LLC | 208810573 - (LA) SPECIALISTS HOSPITAL SHREVEPORT, L.L.C. | LA | General Acute Care Hospital (282N00000X) |
United | 87116 | $10.80 | 1639422504 - EMERUS BHS SA THOUSAND OAKS, LLC, BAPTIST NEIGHBORHOOD HOSPITAL SCHERTZ | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 87116 | $9.72 | 1225450588 - PARISH HOSPITAL SERVICE DISTRICT FOR THE PARISH OF ORLEANS, NEW ORLEANS EAST HOSPITAL | 273335876 | LA | General Acute Care Hospital (282N00000X) |
United | 87116 | $10.80 | 1831970532 - VHS SAN ANTONIO PARTNERS, LLC | 760714523 | TX | General Acute Care Hospital (282N00000X) |
United | 87116 | $10.80 | 1811942238 - KPH-CONSOLIDATION, INC., HCA HOUSTON HEALTHCARE NORTH CYPRESS A CAMPUS OF HCA HOUSTON HEALTHCAR | 621619857 | TX | General Acute Care Hospital (282N00000X) |
United | 87116 | $10.80 | 1851343909 - VICTORIA OF TEXAS LP, DETAR HEALTHCARE SYSTEM | 621754940 | TX | General Acute Care Hospital (282N00000X) |
United | 87116 | $10.80 | 1306897277 - COLUMBIA MEDICAL CENTER OF DENTON SUBSIDIARY LP, MEDICAL CITY DENTON | 621682213 - (TX) COLUMBIA MEDICAL CENTER OF DENTON SUBSIDIARY LP | TX | General Acute Care Hospital (282N00000X) |
United | 87116 | $10.80 | 1568818417 - METHODIST HOSPITALS OF DALLAS, METHODIST SOUTHLAKE MEDICAL CENTER | 750800661 - METHODIST HOSPITALS OF DALLAS | TX | General Acute Care Hospital (282N00000X) |
United | 87116 | $13.77 | 1407947336 - CLHG-VILLE PLATTE LLC, MERCY REGIONAL MEDICAL CENTER | 824681222 | LA | General Acute Care Hospital (282N00000X) |
United | 87116 | $6.34 | 1144227935 - CONCORDIA PARISH HOSPITAL SERVICE DISTRICT NUMBER ONE, TRINITY MEDICAL | 720578642 - (LA) RIVERLAND MEDICAL CENTER | LA | Critical Access Hospital (282NC0060X) |
United | 87116 | $12.96 | 1609971019 - SCURRY COUNTY HOSPITAL DISTRICT, COGDELL MEMORIAL HOSPITAL | 752403687 - (TX) SCURRY COUNTY HOSPITAL DISTRICT | TX | General Acute Care Hospital (282N00000X) |
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 87116 vs. Other Microbiology Procedures Codes
The CPT 87116 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 87116 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 | Culture;Fungi;Isol;Skin |
| 87102-CPT | Low | Culture, Fungi (Mold Or Yeast) Isolation, With Presumptive Identification Of Isolates; Other Source (Except Blood) |
| 87103-CPT | Low | Culture, Fungi, Isolation; Blood |
| 87116-CPT | Low | Culture, Tubercle Or Other Acid-Fast Bacilli (Eg, Tb, Afb, Mycobacteria) Any Source, With Isolation And Presumptive Identification Of Isolates |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87116. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87116 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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