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See a sample rate comparisonCPT 87516 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 Chronic Hepatitis B, This Test Examines Genetic Material Of The Hepatitis B Virus To Find Out Whether The Infection Is Chronic. Hepatitis B Can Damage The Liver. Testing Also Monitors The Response To Treatment.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Microbiology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| 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 87516 |
| Medicaid Fee Schedule | $32.28 median of the 8 states in the free preview · View Medicaid rates for 87516 |
National average reimbursement for CPT 87516 by major payers:
$34.29
$25.55
$36.74
$50.94
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CPT 87516
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$77.20Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$41.69Published rateOconee Medical Center
Prisma Health - Upstate
$31.57Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$30.13Published rateBradley Weisner
Urology Specialists Of The Carolinas, PLLC
$17.13Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 87516 vs. Other Microbiology Procedures Codes
The CPT 87516 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 87516 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 |
|---|---|---|
| 87516-CPT | Low | Test For Chronic Hepatitis B, This Test Examines Genetic Material Of The Hepatitis B Virus To Find Out Whether The Infection Is Chronic. Hepatitis B Can Damage The Liver. Testing Also Monitors The Response To Treatment. |
| 87517-CPT | Low | Test For Chronic Hepatitis B, This Test Examines Genetic Material Of The Hepatitis B Virus To Find Out Whether The Infection Is Chronic. Hepatitis B Can Damage The Liver. Testing Also Monitors The Response To Treatment. |
| 87520-CPT | Low | Test For Hepatitis C Virus, Hepatitis C Is A Virus That Can Damage The Liver. This Blood Test Detects Hepatitis C Genetic Material. The Test Is Used To Verify A Current Infection Or Monitor Response To Treatment Of A Chronic Infection. |
| 87521-CPT | Low | Test For Hepatitis C Virus, Hepatitis C Is A Virus That Can Damage The Liver. This Blood Test Detects Hepatitis C Genetic Material. The Test Is Used To Verify A Current Infection Or Monitor Response To Treatment Of A Chronic Infection. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87516. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87516 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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