CPT 87497 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 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 26 - Professional component 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 87497 |
| Medicaid Fee Schedule | View Medicaid rates for 87497 |
National average reimbursement for CPT 87497 by major payers:
$40.29
$31.36
$50.91
$62.13
CPT 87497 vs. Other Microbiology Procedures Codes
The CPT 87497 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 87497 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 |
|---|---|---|
| 87495-CPT | Low | Cytomegalovirus (Cmv) Test, A Test Of The Genetic Material Found In A Virus That Verifies Whether There Is An Infection By Cytomegalovirus (Cmv). Results Can Help Direct As Well As Measure Response To Treatment. |
| 87496-CPT | Low | Cytomegalovirus (Cmv) Test, A Test Of The Genetic Material Found In A Virus That Verifies Whether There Is An Infection By Cytomegalovirus (Cmv). Results Can Help Direct As Well As Measure Response To Treatment. |
| 87497-CPT | Low | Cytomegalovirus (Cmv) Test, A Test Of The Genetic Material Found In A Virus That Verifies Whether There Is An Infection By Cytomegalovirus (Cmv). Results Can Help Direct As Well As Measure Response To Treatment. |
| 87498-CPT | Low | Enterovirus Probe Revrs Trns, Infectious Agent Detection By Nucleic Acid Dna Or Rna Enterovirus Amplified Probe Technique Includes Reverse Transcription When Performed |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87497. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87497 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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