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See a sample rate comparisonCPT 87265 Fee Schedule
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.
Infectious Agent Antigen Detec, Infectious Agent Antigen Detection By Direct Fluorescentantibody Technique Bordetella Pertussisparapertussis Infectious Agent Antigen Detection By Direct Fluorescent
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Microbiology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | None PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments QW - CLIA Waived Tests |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 87265 |
| Medicaid Fee Schedule | View Medicaid rates for 87265 |
National average reimbursement for CPT 87265 by major payers:
$11.79
$8.68
$13.26
$17.63
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CPT 87265
5 of 25 sample ratesHigher to lower in this preview
Restorative Health Rehabilitation Inc
$55.00Published rateChristopher Raio
St Francis Hospital
$14.23Published rateSt Davids Healthcare Partnership Lp LLP, Round Rock Medical Center
$11.97Published rateOconee Medical Center
Prisma Health - Upstate
$10.77Published rateBrittany Ptachick
Hroa 401k Plan
$5.03Published rate
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See a sample payer proposalCPT 87265 vs. Other Microbiology Procedures Codes
The CPT 87265 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 87265 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 |
|---|---|---|
| 87260-CPT | Low | Infectious Agent Antigen Detec, Infectious Agent Antigen Detection By Direct Fluorescentantibody Technique Adenovirus Infectious Agent Antigen Detection By Direct Fluorescent |
| 87265-CPT | Low | Infectious Agent Antigen Detec, Infectious Agent Antigen Detection By Direct Fluorescentantibody Technique Bordetella Pertussisparapertussis Infectious Agent Antigen Detection By Direct Fluorescent |
| 87267-CPT | Low | Test For Enterovirus Infection, This Test Detects The Presence Of An Enterovirus. This Virus Creates Symptoms Similar To A Cold Or Flu With A Rash. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87265. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87265 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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