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Last Verified: October 2026
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.
Microscopic Lab Test, This Test Is Done To Find Which Organism Is Causing An Infection. A Fluid Or Tissue Sample Is Smeared Onto A Slide Or Container And A Stain Is Added To Help See Bacteria Viruses Parasites Or Cells.
| 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 |
| Medicare Fee Schedule | View Medicare rates for 87209 |
| Medicaid Fee Schedule | View Medicaid rates for 87209 |
National average reimbursement for CPT 87209 by major payers:
$17.86
$12.73
$20.36
$50.59
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CPT 87209
5 of 25 sample ratesHigher to lower in this preview
Dallas Vamc
$25.11Published rateMethodist Hospitals Of Dallas, Methodist Mansfield Medical Center
Methodist Hospitals Of Dallas
$17.97Published rateLake Surgical Hospital Slidell, LLC, Southern Surgical Hospital
Lake Surgical Hospital Slidell, LLC Dba Southern Surgical Hospital
$17.97Published rateSt Helena Parish Hospital, St Helena Parish Hospital
St Helena Parish Hospital
$15.43Published ratePark Place Surgery Center, LLC, Park Place Surgical Hospital
Park Place Surgical Hospital
$6.46Published rate
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See a sample payer proposalCPT 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 | Test To Select Antibiotic, The Antibiotic Sensitivity Test Measures The Reaction Of Bacteria To An Antibiotic. The Result May Be Indicated As Sensitive Susceptible Indeterminate (No Clear Effect) Or Resistant. |
| 87205-CPT | Low | Microscopic Lab Test, This Test Is Done To Find Which Organism Is Causing An Infection. A Fluid Or Tissue Sample Is Smeared Onto A Slide Or Container And A Stain Is Added To Help See Bacteria Viruses Parasites Or Cells. |
| 87206-CPT | Low | Microscopic Lab Test, This Test Is Done To Find Which Organism Is Causing An Infection. A Fluid Or Tissue Sample Is Smeared Onto A Slide Or Container And A Stain Is Added To Help See Bacteria Viruses Parasites Or Cells. |
| 87209-CPT | Low | Microscopic Lab Test, This Test Is Done To Find Which Organism Is Causing An Infection. A Fluid Or Tissue Sample Is Smeared Onto A Slide Or Container And A Stain Is Added To Help See Bacteria Viruses Parasites Or Cells. |
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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