CPT 87428 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 | 11 - Office 20 - Urgent Care Facility |
| Common Modifiers | None QW - CLIA Waived Tests 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 87428 |
| Medicaid Fee Schedule | View Medicaid rates for 87428 |
National average reimbursement for CPT 87428 by major payers:
$54.77
$48.92
$83.25
$98.24
CPT 87428 vs. Other Microbiology Procedures Codes
The CPT 87428 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 87428 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 |
|---|---|---|
| 87427-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; Shiga-Like Toxin (Desc Rvsd 10/6/20) |
| 87428-CPT | Low | Sarscov Inf Vir A B Ag Ia, Infectious Agent Antigen Detection By Immunoassay Technique Eg Enzyme Immunoassay Eia Enzyme Linked Immunosorbent Assay Elisa Fluorescence Immunoassay Fia Immunochemiluminometric Assay Imca Qualitative Or Semiquantitative Severe Acute Respiratory Syndrome Coronavirus Eg Sars Cov Sars Cov 2 Covid 19 And Influenza Virus Types A And B |
| 87430-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; Streptococcus Group A (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 87428. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87428 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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