CPT 87206 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 • 21 - Inpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • 59 - Distinct Procedural Service |
| Complexity Level | Low |
National average reimbursement for CPT 87206 by major payers:
$5.52
$3.87
$6.58
$8.05
| 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 87206 | ||||||
United | 87206 | $4.84 | 1821760430 - PRISMA HEALTH-UPSTATE | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 87206 | $4.84 | 1720747496 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH TRANSPLANT CENTER | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 87206 | $3.15 | 1427387547 - ASHLEY BALAKER | 953856252 - (CA) HEAD AND NECK ASSOCIATES OF ORANGE COUNTY, INC. | CA | Otolaryngology Physician (207Y00000X) |
United | 87206 | $3.15 | 1386648715 - SUNIL SAINI | 953856252 - (CA) HEAD AND NECK ASSOCIATES OF ORANGE COUNTY, INC. | CA | Specialist (174400000X) |
United | 87206 | $3.15 | 1861528663 - QUANG LUU | 953856252 - (CA) HEAD AND NECK ASSOCIATES OF ORANGE COUNTY, INC. | CA | Otolaryngology Physician (207Y00000X) |
United | 87206 | $2.75 | 1831441641 - HARDIK THAKKAR | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | IL | Physician Assistant (363A00000X) |
United | 87206 | $3.23 | 1477673630 - AMALIA STEFANOU | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | MI | Colon & Rectal Surgery Physician (208C00000X) |
United | 87206 | $3.23 | 1386823680 - LISA BETHEA | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Anesthesiology Physician (207L00000X) |
United | 87206 | $4.84 | 1417505694 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH HILLCREST HOSPITAL VASCULAR LAB | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 87206 | $4.84 | 1255367637 - OCONEE MEDICAL CENTER | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 87206 | $5.38 | 1952538431 - METHODIST MCKINNEY HOSPITAL LLC | 208847736 - (TX) METHODIST MCKINNEY HOSPITAL LLC | TX | General Acute Care Hospital (282N00000X) |
United | 87206 | $5.38 | 1205189172 - EMERUS BHS SA THOUSAND OAKS, LLC, BAPTIST NEIGHBORHOOD HOSPITAL OVERLOOK | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 87206 | $2.75 | 1376510214 - ALLEN CAMPBELL | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | MI | Certified Registered Nurse Anesthetist (367500000X) |
United | 87206 | $4.84 | 1841746948 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH CANCER INST-GREER | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 87206 | $2.75 | 1598308454 - KELLY STEVENS | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Family Nurse Practitioner (363LF0000X) |
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 87206 vs. Other Microbiology Procedures Codes
The CPT 87206 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 87206 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 |
|---|---|---|
| 87197-CPT | Low | Serum Bactericidal Titer (Schlichter Test) |
| 87205-CPT | Low | Smear, Primary Source, With Interpretation;Gram Or Giemsa Stain For Bacteria,Fungi, Or Cell Types |
| 87206-CPT | Low | Smear, Primary Source With Interpretation; Fluorescent And/Or Acid Fast Stain For Bacteria, Fungi, Parasites, Viruses Or Cell Types |
| 87207-CPT | Low | Special Stain For Inclusion Bodies Or Parasites (Eg Malaria Coccidia Microsporidia Trypanosomes Herpes Viruses) (Desc Rev 01/01/03) Galovirus Herpes Viruses) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87206. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87206 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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