CPT 87503 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 21 - Inpatient Hospital |
| Common Modifiers | None 26 - Professional component 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 87503 |
| Medicaid Fee Schedule | View Medicaid rates for 87503 |
National average reimbursement for CPT 87503 by major payers:
$26.19
$17.32
$27.12
$70.30
CPT 87503 vs. Other Microbiology Procedures Codes
The CPT 87503 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 87503 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 |
|---|---|---|
| 87501-CPT | Low | Influenza Dna Amp Prob 1, Infectious Agent Detection By Nucleic Acid Dna Or Rna Influenza Virus Includes Reverse Transcription When Performed And Amplified Probe Technique Each Type Or Subtype |
| 87502-CPT | Low | Infectious Agent Detection By Nucleic Acid (Dna Orrna); Influenza Virus For Multiple Types Or Sub-Types Includes Multiplex Reverse Transcription When Performed And Multiplex Amplified Probe Technique First 2 Types Or Sub-Types (Revised 01/01/2016) |
| 87503-CPT | Low | Infectious Agent Detection By Nucleic Acid (Dna Orrna); Influenza Virus For Multiple Types Or Sub-Types Includes Multiplex Reverse Transcription When Performed And Multiplex Amplified Probe Technique Each Additional Influenza Virus Type Or Sub-Type Beyond 2 (List Separately In Addition To Code For Primary Procedure) Revised 01/01/2016 |
| 87505-CPT | Low | Nfct Agent Detection Gi, Infectious Agent Detection By Nucleic Acid Dna Or Rna 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 87503. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87503 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 87503) and we'll show you how you compare in 15 minutes or less.