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See a sample rate comparisonCPT 87511 Fee Schedule
Last Verified: October 2026
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.
Test For Vaginal Infection, The Test Evaluates A Sample Of Vaginal Discharge Or Fluid For Gardnerella Bacteria. The Infection Causes Discharge And Irritation.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Microbiology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office 20 - Urgent Care Facility |
| Common Modifiers | 59 - Distinct Procedural Service 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | $35.09 national lab fee schedule rate (2026) · View Medicare rates for 87511 |
| Medicaid Fee Schedule | $32.72 median of the 8 states in the free preview · View Medicaid rates for 87511 |
National average reimbursement for CPT 87511 by major payers:
$32.80
$25.23
$36.85
$51.28
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CPT 87511
5 of 25 sample ratesHigher to lower in this preview
Da Pediatric Rehabilitation
$60.00Published rateUniversity Of Texas Health Science Center At Tyler
$35.09Published rateAnn Steck
Toledo Hospital
$27.62Published rateNevada Eye Care Professionals Little & Stein, Ltd.
Nevada Eye Care Professionals
$20.60Published rateEl Campo Memorial Hospital
$14.73Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 87511 vs. Other Microbiology Procedures Codes
The CPT 87511 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 87511 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 |
|---|---|---|
| 87510-CPT | Low | Infectious Agent Detection By, Infectious Agent Detection By Nucleic Acid (Dna Orrna)Gardnerella Vaginalis Direct Probe Techniqu E Infectious Agent Detection By Nucleic Acid (Dnaor Rna) |
| 87511-CPT | Low | Test For Vaginal Infection, The Test Evaluates A Sample Of Vaginal Discharge Or Fluid For Gardnerella Bacteria. The Infection Causes Discharge And Irritation. |
| 87512-CPT | Low | Infectious Agent Detection By, Infectious Agent Detection By Nucleic Acid (Dna Orrna)Gardnerella Vaginalis Quantification Infec Tious Agent Detection By Nucleic Acid (Dna Or Rna) |
| 87513-CPT | Low | H Pylri Clrthmcn Rst Amp Prb, Infectious Agent Detection By Nucleic Acid (Dna Or Rna); Helicobacter Pylori (H. Pylori) Clarithromycin Resistance Amplified Probe Technique |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87511. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87511 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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