CPT 87255 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 87255 by major payers:
$32.15
$23.80
$37.39
$50.20
| 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 87255 | ||||||
United | 87255 | $20.31 | 1487684122 - UNION COUNTY HOSPITAL AUTHORITY, UNION GENERAL HOSPITAL | 586025393 - (GA) UNION COUNTY HOSPITAL AUTHORITY | GA | General Acute Care Hospital (282N00000X) |
United | 87255 | $71.86 | 1447391941 - MICHAEL MOORE | 431598353 - SAINT LUKES PHYSICIAN GROUP INC | KS | Obstetrics & Gynecology Physician (207V00000X) |
United | 87255 | $14.22 | 1982608857 - CATHY TAYLOR | 486075784 - (KS) NEOSHO MEMORIAL REGIONAL MEDICAL CENTER | KS | Obstetrics & Gynecology Physician (207V00000X) |
United | 87255 | $20.31 | 1417122706 - KLAS MILLER | 480559088 - (KS) HAYS MEDICAL CENTER INC | KS | Obstetrics & Gynecology Physician (207V00000X) |
United | 87255 | $19.37 | 1598102808 - JESSICA POTEET | 910757683 | KS | Obstetrics & Gynecology Physician (207V00000X) |
United | 87255 | $20.31 | 1245769025 - JORDAN MEYER | 800677957 | KS | Obstetrics & Gynecology Physician (207V00000X) |
United | 87255 | $71.86 | 1720234107 - CECILY CLARK-GANHEART | 431598353 - SAINT LUKES PHYSICIAN GROUP INC | KS | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 87255 | $71.86 | 1972507366 - BRET GORDON | 431598353 - SAINT LUKES PHYSICIAN GROUP INC | KS | Obstetrics & Gynecology Physician (207V00000X) |
United | 87255 | $50.79 | 1457884553 - WHITNEY KLEINMANN | 481163756 - KANSAS UNIVERSITY PHYSICIANS INC | KS | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 87255 | $20.31 | 1184735508 - JAMES DELMORE | 900419749 - (MO) MIDWEST ONCOLOGY ASSOCIATES LLC | KS | Gynecologic Oncology Physician (207VX0201X) |
United | 87255 | $13.53 | 1053396200 - DAVID LANG | 833065262 - (AR) OBHG ARKANSAS WEST PA | KS | Obstetrics & Gynecology Physician (207V00000X) |
United | 87255 | $20.31 | 1972761740 - KARI HAMLIN | 320312777 - (KS) HEARTLAND WOMENS GROUP AT WESLEY LLC | KS | Obstetrics & Gynecology Physician (207V00000X) |
United | 87255 | $82.48 | 1225281603 - EMORY CRAWFORD LONG HOSPITAL | 582030692 - EMORY UNIVERSITY | GA | General Acute Care Hospital (282N00000X) |
United | 87255 | $41.90 | 1780638833 - CARTERSVILLE MEDICAL CENTER LLC, CARTERSVILLE MEDICAL CENTER | 582433438 - (GA) CARTERSVILLE MEDICAL CENTER LLC | GA | General Acute Care Hospital (282N00000X) |
United | 87255 | $24.90 | 1811962756 - EFFINGHAM HOSPITAL, INC., EFFINGHAM HEALTH SYSTEM | 474393589 - (GA) EFFINGHAM HOSPITAL INC | GA | Critical Access Hospital (282NC0060X) |
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 87255 vs. Other Microbiology Procedures Codes
The CPT 87255 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 87255 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 |
|---|---|---|
| 87254-CPT | Low | Centrifuge Enhanced (Shell Vial) Technique Includes Identification With Immunofluorescence Stain Each Virus (Desc Rev 01/01/03) |
| 87255-CPT | Low | Virus Isolation; Including Identification By Non-Immunologic Method, Other Than By Cytopathic Effect (Eg, Virus Specific Enzymatic Activity) |
| 87260-CPT | Low | Antigen Detection By Fluorescent Antibody Technique; Adenovirus |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87255. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87255 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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