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 |
| Medicare Fee Schedule | View Medicare rates for 87220 |
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 | $3.63 | 1235685892 - FAIRFIELD HOSPITAL DISTRICT, FREESTONE MEDICAL CENTER | 741774669 | TX | General Acute Care Hospital (282N00000X) |
United | 87220 | $3.63 | 1295736734 - CHRISTUS HEALTH ARK-LA-TEX, CHRISTUS ST. MICHAEL HEALTH SYSTEM | 752616977 - CHRISTUS TRINITY CLINIC | TX | General Acute Care Hospital (282N00000X) |
United | 87220 | $2.55 | 1245726991 - HOPE BARONE | 452971242 - (RI) ROBERT K. DYER, MD, DERMATOLOGY LLC | MA | Dermatology Physician (207N00000X) |
United | 87220 | $4.26 | 1871668640 - KENNETH M REED MD PC, <UNAVAIL> | 43214763 - (MA) KENNETH M. REED, M.D., P.C. | MA | Dermatology Physician (207N00000X) |
United | 87220 | $4.26 | 1992831309 - YOLANDA LENZY | 464553517 - (MA) LENZY DERMATOLOGY, PC | MA | Dermatology Physician (207N00000X) |
United | 87220 | $12.78 | 1386202158 - NIKOLAI KLEBANOV | 42704683 - (MA) LAHEY CLINIC INC | MA | Dermatology Physician (207N00000X) |
United | 87220 | $2.84 | 1063977999 - FRAMINGHAM DERMATOLOGY, <UNAVAIL> | 833242900 | MA | Dermatology Physician (207N00000X) |
United | 87220 | $3.57 | 1275581852 - ROLLING PLAINS MEMORIAL HOSPITAL | 756003896 - (TX) THE NOLAN COUNTY HOSPITAL DISTRICT | TX | General Acute Care Hospital (282N00000X) |
United | 87220 | $24.48 | 1295726396 - JESSICA FEWKES | 42697983 - MASS GENERAL BRIGHAM INCORPORATED | MA | MOHS-Micrographic Surgery Physician (207ND0101X) |
United | 87220 | $24.48 | 1457918229 - MADELIENE STUMP | 42312909 - MASS GENERAL BRIGHAM INCORPORATED | MA | Dermatology Physician (207N00000X) |
United | 87220 | $4.26 | 1952538431 - METHODIST MCKINNEY HOSPITAL LLC | 208847736 - (TX) METHODIST MCKINNEY HOSPITAL LLC | TX | General Acute Care Hospital (282N00000X) |
United | 87220 | $2.55 | 1174926190 - SAM KHALIFIAN | 932124805 - (CA) SOM MEDICAL SERVICES | CA | Procedural Dermatology Physician (207NS0135X) |
United | 87220 | $3.57 | 1508859612 - GONZALES HEALTHCARE SYSTEMS, MEMORIAL HOSPITAL | 741625013 | TX | General Acute Care Hospital (282N00000X) |
United | 87220 | $4.26 | 1417388711 - NAURA SHAH | 863817307 - (MA) DA MASS PC | 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 | 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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