CPT 87469 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 • 59 - Distinct Procedural Service • 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 87469 |
National average reimbursement for CPT 87469 by major payers:
$31.94
$21.46
$38.28
$80.49
| 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 87469 | ||||||
United | 87469 | $12.78 | 1588098172 - PROGRESSIVE EMERGENCY PHYSICIANS PLLC | 463316332 - PROGRESSIVE EMERGENCY PHYSICIANS PLLC | NY | Multi-Specialty Group (193200000X) |
United | 87469 | $14.74 | 1366428401 - AARON ASKEW | 931261079 - THE ORTHOPEDIC AND NEUROSURGICAL CENTER OF THE CASCADES | OR | Orthopaedic Trauma Physician (207XX0801X) |
United | 87469 | $86.43 | 1861807174 - EVAN KRUEGER | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Neurological Surgery Physician (207T00000X) |
United | 87469 | $35.05 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 87469 | $14.73 | 1023438009 - MOLLY MCINTOSH | 593140335 - BAYCARE MEDICAL GROUP INC | FL | Home Health Agency (251E00000X) |
United | 87469 | $46.32 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 87469 | $18.95 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 87469 | $25.87 | 1720087513 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
United | 87469 | $14.03 | 1366400376 - SUNRISE HOME HEALTH CARE INC. | 650307774 - (FL) SUNRISE HOME HEALTH CARE INC | FL | Home Health Agency (251E00000X) |
United | 87469 | $14.74 | 1730106824 - NEVADA EYE CARE PROFESSIONALS LITTLE & STEIN, LTD. | 880316581 - NEVADA EYE CARE PROFESSIONALS | NV | Ophthalmology Physician (207W00000X) |
United | 87469 | $21.05 | 1497944565 - MICHAEL SHULER | 581076549 - ATHENS ORTHOPEDIC CLINIC, P.A. | GA | Orthopaedic Hand Surgery Physician (207XS0106X) |
United | 87469 | $14.74 | 1053866707 - BRITTANY PTACHICK | 541958039 - HROA 401K PLAN | VA | Family Nurse Practitioner (363LF0000X) |
United | 87469 | $46.32 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 87469 | $14.74 | 1366428401 - AARON ASKEW | 911750212 - DESERT BONE & JOINT SPECIALISTS, LLP | OR | Orthopaedic Trauma Physician (207XX0801X) |
United | 87469 | $25.87 | 1295728186 - BAYCARE HOME CARE, INC. | 593582520 - (FL) BAYCARE HOME CARE INC | FL | Home Health Agency (251E00000X) |
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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 87469 vs. Other Microbiology Procedures Codes
The CPT 87469 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 87469 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 |
|---|---|---|
| 87468-CPT | Low | Infectious Agent Detection By Nucleic Acid (Dna Or Rna); Anaplasma Phagocytophilum, Amplified Probe Technique |
| 87469-CPT | Low | Infectious Agent Detection By Nucleic Acid (Dna Or Rna); Babesia Microti, Amplified Probe Technique |
| 87471-CPT | Low | Infectious Agent Detection By Nucleic Acid (Dna Or Rna); Bartonella Henselae And Bartonella Quintana, Amplified Probe Technique |
| 87472-CPT | Low | Nucleic Acid Detection; Bartonella Henselae & Quintana, Quantification |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87469. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87469 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 87469) and we'll show you how you compare in 15 minutes or less.