CPT 87520 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 • 90 - Reference Laboratory • QW - CLIA Waived Tests |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 87520 |
National average reimbursement for CPT 87520 by major payers:
$28.04
$18.37
$29.79
$44.80
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 87520 | ||||||
United | 87520 | $18.73 | 1861650780 - CHILDRENS NATIONAL MEDICAL CENTER | 530196580 - CHILDRENS HOSPITAL | DC | Children's Hospital (282NC2000X) |
United | 87520 | $31.22 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 87520 | $15.78 | 1033320049 - ANN STECK | 344428256 - TOLEDO HOSPITAL | OH | Family Medicine Physician (207Q00000X) |
United | 87520 | $28.10 | 1629432869 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH OP SURGERY SPARTANBURG | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 87520 | $15.62 | 1164776688 - NICOLE SCHWAB | 362925195 - ALLERGY & ASTHMA OF DUPAGE, S.C. | IL | Family Nurse Practitioner (363LF0000X) |
United | 87520 | $31.21 | 1154618742 - VHS HARLINGEN HOSPITAL COMPANY LLC, VALLEY BAPTIST MEDICAL CENTER | 452662980 | TX | General Acute Care Hospital (282N00000X) |
United | 87520 | $60.00 | 1649599168 - RESTORATIVE HEALTH REHABILITATION INC | 272533824 - (FL) RESTORATIVE HEALTH REHABILITATION INC | FL | Home Health Agency (251E00000X) |
United | 87520 | $27.48 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 87520 | $34.34 | 1366428401 - AARON ASKEW | 931224010 - PRAXIS HEALTH, P.C. | OR | Orthopaedic Trauma Physician (207XX0801X) |
United | 87520 | $28.10 | 1902352008 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH CANCER INST-SPARTANBURG | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 87520 | $27.48 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 87520 | $31.21 | 1821026816 - EAST COOPER COMMUNITY HOSPITAL, INC., EAST COOPER MEDICAL CENTER | 934555562 | SC | General Acute Care Hospital (282N00000X) |
United | 87520 | $28.10 | 1437605532 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH CENTER FOR PEDIATRIC MED | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 87520 | $13.11 | 1053866707 - BRITTANY PTACHICK | 541958039 - HROA 401K PLAN | VA | Family Nurse Practitioner (363LF0000X) |
United | 87520 | $18.73 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 87520 vs. Other Microbiology Procedures Codes
The CPT 87520 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 87520 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 |
|---|---|---|
| 87520-CPT | Low | Nucleic Acid Detection; Hepatitis C, Direct Probe Technique |
| 87521-CPT | Low | Infectious Agent Detection By Nucleic Acid (Dna Orrna); Hepatitis C Amplified Probe Technique Includes Reverse Transcription When Performed (Revised 01/01/2014) |
| 87522-CPT | Low | Infectious Agent Detection By Nucleic Acid (Dna Orrna); Hepatitis C Quantification Includes Reverse Transcription When Performed (Revised 01/01/2014) |
| 87523-CPT | Moderate | Infectious Agent Detection By Nucleic Acid (Dna Or Rna); Hepatitis D (Delta), Quantification, Including 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 87520. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87520 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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