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See a sample rate comparisonCPT 87425 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 Detection By Immunoassay Technique (Eg Enzyme Immunoassay [Eia] Enzyme- Linked Immunosorbent Assay [Elisa] Fluorescence Immunoassay [Fia] Immuno- Chemiluminometric Assay [Imca]) Qualitative Or Semiquantitative; Rotavirus (Desc Rvsd 10/6/20)
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Microbiology Procedures |
| Common Place of Service | 81 - Independent Laboratory 21 - Inpatient Hospital |
| Common Modifiers | None 26 - Professional component 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 87425 |
| Medicaid Fee Schedule | View Medicaid rates for 87425 |
National average reimbursement for CPT 87425 by major payers:
$11.70
$8.63
$13.59
$18.01
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CPT 87425
5 of 25 sample ratesHigher to lower in this preview
All Ways Homecare Inc
$55.00Published rateAaron Askew
Praxis Health, P.C.
$13.18Published rateChu Chen
Merrimack Valley Pediatric Associates, Inc.
$11.98Published ratePrisma Health-Upstate, Prisma Health Ctr For Ped & Int Med-West
Prisma Health - Upstate
$10.77Published rateSt Davids Healthcare Partnership Lp LLP, Round Rock Medical Center
Lone Star Circle Of Care
$5.03Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 87425 vs. Other Microbiology Procedures Codes
The CPT 87425 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 87425 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 |
|---|---|---|
| 87420-CPT | Low | Infectious Agent Antigen Detection By Immunoassay Technique (Eg Enzyme Immunoassay [Eia] Enzyme- Linked Immunosorbent Assay [Elisa] Fluorescence Immunoassay [Fia] Immuno- Chemiluminometric Assay [Imca]) Qualitative Or Semiquantitative; Respiratory Syncytial Virus (Desc Rvsd 10/6/20) |
| 87425-CPT | Low | Infectious Agent Antigen Detection By Immunoassay Technique (Eg Enzyme Immunoassay [Eia] Enzyme- Linked Immunosorbent Assay [Elisa] Fluorescence Immunoassay [Fia] Immuno- Chemiluminometric Assay [Imca]) Qualitative Or Semiquantitative; Rotavirus (Desc Rvsd 10/6/20) |
| 87426-CPT | Low | Infectious Agent Antigen Detection By Immunoassay Technique (Eg Enzyme Immunoassay [Eia] Enzyme- Linked Immunosorbent Assay [Elisa] Fluorescence Immunoassay [Fia] Immuno- Chemiluminometric Assay [Imca]) Qualitative Or Semiquantitative; Severe Acute Respiratory Syndrome Coronavirus (Eg Sars-Cov Sars-Cov-2 [Covid-19]) (Desc Rvsd 10/6/20) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87425. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87425 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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