CPT 87491 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 87491 |
| Medicaid Fee Schedule | View Medicaid rates for 87491 |
National average reimbursement for CPT 87491 by major payers:
$32.07
$25.09
$41.98
$88.29
CPT 87491 vs. Other Microbiology Procedures Codes
The CPT 87491 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 87491 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 |
|---|---|---|
| 87485-CPT | Low | Infectious Agent Detection By, Infectious Agent Detection By Nucleic Acid (Dna Orrna)Chlamydia Pneumoniae Direct Probe Technique Infectious Agent Detection By Nucleic Acid (Dna Or Rna) |
| 87490-CPT | Low | Test To Confirm Chlamydia, This Is A Test For Confirming Infection With Chlamydia Trachomatis Commonly Transmitted Through Sexual Contact. The Sample Tested May Be Taken From The Cervix Urethra Or Urine. |
| 87491-CPT | Low | Test To Confirm Chlamydia, This Is A Test For Confirming Infection With Chlamydia Trachomatis Commonly Transmitted Through Sexual Contact. The Sample Tested May Be Taken From The Cervix Urethra Or Urine. |
| 87492-CPT | Low | Test To Confirm Chlamydia, This Is A Test For Confirming Infection With Chlamydia Trachomatis Commonly Transmitted Through Sexual Contact. The Sample Tested May Be Taken From The Cervix Urethra Or Urine. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87491. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87491 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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