CPT 87521 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 • 59 - Distinct Procedural Service • 91 - Repeat Lab Test |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 87521 |
National average reimbursement for CPT 87521 by major payers:
$33.47
$25.45
$37.97
$52.18
| 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 87521 | ||||||
United | 87521 | $16.37 | 1689650921 - EASTLAND MEMORIAL HOSPITAL DISTRICT, EASTLAND MEMORIAL HOSPITAL | 752313255 | TX | General Acute Care Hospital (282N00000X) |
United | 87521 | $35.09 | 1275235426 - EMERUS BHS SA THOUSAND OAKS LLC | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 87521 | $14.73 | 1174526529 - TITUS COUNTY HOSPITAL DISTRICT, TITUS REGIONAL MEDICAL CENTER | 756003935 | TX | General Acute Care Hospital (282N00000X) |
United | 87521 | $20.60 | 1801893417 - SMITHVILLE HOSPITAL AUTHORITY, SMITHVILLE REGIONAL HOSPITAL | 741706734 | TX | General Acute Care Hospital (282N00000X) |
United | 87521 | $49.04 | 1124078563 - TEMPLE VAMC, WACO VAMC | 742791419 | TX | General Acute Care Hospital (282N00000X) |
United | 87521 | $35.09 | 1659323772 - COLUMBIA PLAZA MEDICAL CENTER OF FORT WORTH SUBSIDIARY LP, MEDICAL CITY FORT WORTH | 621682202 - (TX) COLUMBIA PLAZA MEDICAL CENTER OF FORT WORTH SUBSIDIARY LP | TX | General Acute Care Hospital (282N00000X) |
United | 87521 | $35.09 | 1588631311 - SURGICAL SPECIALTY CENTER OF BATON ROUGE, LLC, SURGICAL SPECIALTY CENTER OF BATON ROUGE | 263120962 - (LA) SURGICAL SPECIALTY CENTER OF BATON ROUGE, LLC | LA | General Acute Care Hospital (282N00000X) |
United | 87521 | $35.09 | 1639422504 - EMERUS BHS SA THOUSAND OAKS, LLC, BAPTIST NEIGHBORHOOD HOSPITAL SCHERTZ | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 87521 | $51.25 | 1225031495 - MONROE SURGICAL HOSPITAL, LLC | 721479756 - (LA) MONROE SURGICAL HOSPITAL | LA | General Acute Care Hospital (282N00000X) |
United | 87521 | $35.09 | 1124170691 - WILLIS KNIGHTON MEDICAL CENTER, INC., WILLIS KNIGHTON SOUTH HOSPITAL | 720400933 - (LA) WILLIS-KNIGHTON MEDICAL CENTER | LA | General Acute Care Hospital (282N00000X) |
United | 87521 | $35.09 | 1700801909 - TENET HOSPITALS LIMITED, THE HOSPITALS OF PROVIDENCE MEMORIAL CAMPUS | 954537720 | TX | General Acute Care Hospital (282N00000X) |
United | 87521 | $35.09 | 1447230388 - OPELOUSAS GENERAL HOSPITAL AUTHORITY | 720708111 | LA | General Acute Care Hospital (282N00000X) |
United | 87521 | $35.09 | 1528027786 - METHODIST HOSPITALS OF DALLAS, METHODIST DALLAS MEDICAL CENTER | 750800661 - METHODIST HOSPITALS OF DALLAS | TX | General Acute Care Hospital (282N00000X) |
United | 87521 | $42.11 | 1609971019 - SCURRY COUNTY HOSPITAL DISTRICT, COGDELL MEMORIAL HOSPITAL | 752403687 - (TX) SCURRY COUNTY HOSPITAL DISTRICT | TX | General Acute Care Hospital (282N00000X) |
United | 87521 | $42.11 | 1275581852 - ROLLING PLAINS MEMORIAL HOSPITAL | 756003896 - (TX) THE NOLAN COUNTY HOSPITAL DISTRICT | TX | General Acute Care Hospital (282N00000X) |
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 87521 vs. Other Microbiology Procedures Codes
The CPT 87521 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 87521 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 87521. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87521 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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