CPT 87476 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 • 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 87476 |
National average reimbursement for CPT 87476 by major payers:
$33.45
$25.53
$40.32
$52.08
| 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 87476 | ||||||
United | 87476 | $20.60 | 1275581852 - ROLLING PLAINS MEMORIAL HOSPITAL | 756003896 - (TX) THE NOLAN COUNTY HOSPITAL DISTRICT | TX | General Acute Care Hospital (282N00000X) |
United | 87476 | $14.74 | 1053866707 - BRITTANY PTACHICK | 541958039 - HROA 401K PLAN | VA | Family Nurse Practitioner (363LF0000X) |
United | 87476 | $20.60 | 1700854288 - LAMB HEALTHCARE CENTER | 752388515 - (TX) LAMB HEALTHCARE CENTER | TX | General Acute Care Hospital (282N00000X) |
United | 87476 | $35.09 | 1003811290 - PROVIDENCE HOSPITAL, LLC, PROVIDENCE HEALTH | 571098556 - (SC) MEDICAL UNIVERSITY HOSPITAL AUTHORITY | SC | General Acute Care Hospital (282N00000X) |
United | 87476 | $46.32 | 1255478004 - CHRISTOPHER RAIO | 208243412 - SAMARITAN EMERGENCY MEDICAL SERVICES PC | NY | Emergency Medicine Physician (207P00000X) |
United | 87476 | $35.09 | 1972503910 - WACCAMAW COMMUNITY HOSPITAL, TIDELANDS WACCAMAW COMMUNITY HOSPITAL | 43633263 - WACCAMAW COMMUNITY HOSPITAL | SC | General Acute Care Hospital (282N00000X) |
United | 87476 | $31.57 | 1841746948 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH CANCER INST-GREER | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 87476 | $21.05 | 1861650780 - CHILDRENS NATIONAL MEDICAL CENTER | 530196580 - CHILDRENS HOSPITAL | DC | Children's Hospital (282NC2000X) |
United | 87476 | $30.16 | 1578583647 - MARC STIEFEL | 202604678 - PINNACLE ENT ALLIANCE, LLC | PA | Otolaryngology Physician (207Y00000X) |
United | 87476 | $35.09 | 1447723945 - MEDICAL UNIVERSITY HOSPITAL AUTHORITY, MUSC HEALTH MARION MEDICAL CENTER | 571098556 - (SC) MEDICAL UNIVERSITY HOSPITAL AUTHORITY | SC | General Acute Care Hospital (282N00000X) |
United | 87476 | $31.57 | 1629432869 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH OP SURGERY SPARTANBURG | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 87476 | $12.27 | 1598375651 - E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC, E AND A HEALTHCARE ON THE GO | 832289173 - (FL) E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC | FL | Home Health Agency (251E00000X) |
United | 87476 | $34.26 | 1619910627 - BRADLEY WEISNER | 562107759 - UROLOGY SPECIALISTS OF THE CAROLINAS, PLLC | NC | Urology Physician (208800000X) |
United | 87476 | $31.57 | 1114473212 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH CANCER INST-FARIS | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 87476 | $17.13 | 1619910627 - BRADLEY WEISNER | 562107759 - UROLOGY SPECIALISTS OF THE CAROLINAS, PLLC | NC | Urology Physician (208800000X) |
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 87476 vs. Other Microbiology Procedures Codes
The CPT 87476 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 87476 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 |
|---|---|---|
| 87475-CPT | Low | Nucleic Acid Detection; Borrelia Burgdorferi, Direct Probe Technique |
| 87476-CPT | Low | Nucleic Acid Detection; Borrelia Burgdorferi, By Amplified Probe |
| 87478-CPT | Low | Infectious Agent Detection By Nucleic Acid (Dna Or Rna); Borrelia Miyamotoi, Amplified Probe Technique |
| 87505-CPT | Low | Infectious Agent Detection By Nucleic Acid (Dna Orrna); Gastrointestinal Pathogen (Eg Clostridium Difficile E. Coli Salmonella Shigella Norovirus Giardia) Includes Multiplex Reverse Transcription When Performed And Multiplex Amplified Probe Technique Multiple Types Or Subtypes 3-5 Targets |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87476. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87476 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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