CPT 87209 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 • 26 - Professional component |
| Complexity Level | Low |
National average reimbursement for CPT 87209 by major payers:
$17.86
$12.73
$20.36
$54.26
| 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 87209 | ||||||
United | 87209 | $25.11 | 1932729803 - DALLAS VAMC | 756108647 | TX | General Acute Care Hospital (282N00000X) |
United | 87209 | $17.97 | 1538667035 - CARTHAGE HOSPITAL, LLC | 824005981 | TX | General Acute Care Hospital (282N00000X) |
United | 87209 | $10.28 | 1407191984 - BSA HOSPITAL LLC | 300754305 | TX | General Acute Care Hospital (282N00000X) |
United | 87209 | $21.57 | 1326079534 - CHILDRESS COUNTY HOSPITAL DISTRICT, CHILDRESS REGIONAL MEDICAL CENTER | 751228349 | TX | General Acute Care Hospital (282N00000X) |
United | 87209 | $10.30 | 1093783391 - CHRISTUS SPOHN HEALTH SYSTEM CORPORATION, CHRISTUS SPOHN HOSPITAL KLEBERG | 760422435 - C H WILKINSON PHYSICIAN NETWORK | TX | General Acute Care Hospital (282N00000X) |
United | 87209 | $21.57 | 1316931835 - WILBARGER COUNTY HOSPITAL DISTRICT, WILBARGER GENERAL HOSPITAL | 756047638 - (TX) WILBARGER GENERAL HOSPITAL EMPLOYEE BENEFIT PLAN | TX | General Acute Care Hospital (282N00000X) |
United | 87209 | $17.97 | 1831970532 - VHS SAN ANTONIO PARTNERS, LLC | 760714523 | TX | General Acute Care Hospital (282N00000X) |
United | 87209 | $17.97 | 1538522412 - TENET HOSPITALS LIMITED, THE HOSPITALS OF PROVIDENCE TRANSMOUNTAIN CAMPUS | 954537720 | TX | General Acute Care Hospital (282N00000X) |
United | 87209 | $17.97 | 1477805406 - EMERUS BHS SA THOUSAND OAKS, LLC, BAPTIST NEIGHBORHOOD HOSPITAL WESTOVER HILLS | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 87209 | $16.18 | 1104057694 - SPECIALISTS HOSPITAL SHREVEPORT, LLC | 208810573 - (LA) SPECIALISTS HOSPITAL SHREVEPORT, L.L.C. | LA | General Acute Care Hospital (282N00000X) |
United | 87209 | $17.97 | 1215969787 - TENET HOSPITALS LIMITED, THE HOSPITALS OF PROVIDENCE SIERRA CAMPUS | 954537720 | TX | General Acute Care Hospital (282N00000X) |
United | 87209 | $15.43 | 1013068808 - ST HELENA PARISH HOSPITAL, ST HELENA PARISH HOSPITAL | 720627145 - (LA) ST HELENA PARISH HOSPITAL | LA | Critical Access Hospital (282NC0060X) |
United | 87209 | $10.81 | 1316936990 - EL PASO COUNTY HOSPITAL DISTRICT, UNIVERSITY MEDICAL CENTER OF EL PASO | 752668018 | TX | General Acute Care Hospital (282N00000X) |
United | 87209 | $9.31 | 1740453000 - GRAHAM REGIONAL MEDICAL CENTER, GRAHAM GENERAL HSOPITAL PHYSICIANS | 463113489 | TX | General Acute Care Hospital (282N00000X) |
United | 87209 | $21.57 | 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 87209 vs. Other Microbiology Procedures Codes
The CPT 87209 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 87209 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 |
| 87209-CPT | Low | Smear, Primary Source With Interpretation; Complex Special Stain (Eg, Trichrome, Iron Hemotoxylin) For Ova And Parasites |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87209. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87209 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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