CPT 87220 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 | • 20 - Urgent Care Facility • 11 - Office • 81 - Independent Laboratory |
| Common Modifiers | • None • 26 - Professional component • QW - CLIA Waived Tests |
| Complexity Level | Low |
National average reimbursement for CPT 87220 by major payers:
$4.32
$3.99
$5.56
$6.48
| 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 87220 | ||||||
United | 87220 | $6.51 | 1578761482 - MEGAN BERNSTEIN | 473026344 - (MA) NEDAS LLC | MA | Dermatology Physician (207N00000X) |
United | 87220 | $12.78 | 1912135153 - JULIA BENEDETTI | 42704683 - (MA) LAHEY CLINIC INC | MA | Dermatology Physician (207N00000X) |
United | 87220 | $24.48 | 1457918229 - MADELIENE STUMP | 42312909 - MASS GENERAL BRIGHAM INCORPORATED | MA | Dermatology Physician (207N00000X) |
United | 87220 | $9.39 | 1689652257 - KATHLEEN JOYCE | 43317992 - (MA) ADULT & PEDIATRIC DERMATOLOGY. P.C. | MA | Dermatology Physician (207N00000X) |
United | 87220 | $4.26 | 1780851386 - GARY MENDESE | 20530225 - (NH) CAMPBELL DERMATOLOGY, P.A. | NH | MOHS-Micrographic Surgery Physician (207ND0101X) |
United | 87220 | $4.26 | 1215963574 - BOSTON DERMATOLOGY AND LASER CENTER, LLC | 43459576 - (MA) BOSTON DERMATOLOGY & LASER CENTER, PC | MA | Dermatology Physician (207N00000X) |
United | 87220 | $8.10 | 1033192976 - SUSAN SWEENEY | 42911067 - UMASS MEMORIAL HEALTH CARE INC | MA | Dermatology Physician (207N00000X) |
United | 87220 | $4.26 | 1629006093 - KAREN MCGINNIS | 272777455 | MA | Dermatology Physician (207N00000X) |
United | 87220 | $3.57 | 1558477869 - NEWTON WATERTOWN DERMATOLOGY ASSOC. PC | 43355366 - (MA) NEWTON WATERTOWN DERMATOLOGY ASS | MA | Dermatology Physician (207N00000X) |
United | 87220 | $2.86 | 1356316020 - OTTER ASPEN | 470973312 | NJ | MOHS-Micrographic Surgery Physician (207ND0101X) |
United | 87220 | $4.19 | 1194352138 - CONNIE ZHONG | 42263040 - (MA) DANA-FARBER CANCER INSTITUTE | MA | Dermatology Physician (207N00000X) |
United | 87220 | $4.26 | 1093784159 - MATTHEW ZIPOLI | 843446998 - (NH) JOSE E. PERAZA, MD, PLLC | MA | MOHS-Micrographic Surgery Physician (207ND0101X) |
United | 87220 | $24.48 | 1386082873 - ANDREW WALLS | 42312909 - MASS GENERAL BRIGHAM INCORPORATED | MA | Dermatology Physician (207N00000X) |
United | 87220 | $12.78 | 1982695664 - THOMAS RUENGER | 472248298 - (MA) BETH ISRAEL LAHEY HEALTH PRIMARY CARE INC | MA | Dermatology Physician (207N00000X) |
United | 87220 | $2.55 | 1669718920 - VANESSA PASCOE | 222768204 - HARVARD MEDICAL FACULTY PHYS AT BETH ISRAEL DEACONESS MED CTR INC | MA | Dermatology Physician (207N00000X) |
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 87220 vs. Other Microbiology Procedures Codes
The CPT 87220 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 87220 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 |
|---|---|---|
| 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) |
| 87220-CPT | Low | Tissue Examination By Koh Slide Of Samples From Skin, Hair, Or Nails For Fungi Or Ectoparasite Ova Or Mites (Eg, Scabies) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87220. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87220 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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