CPT 87522 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 • 26 - Professional component |
| Complexity Level | Low |
National average reimbursement for CPT 87522 by major payers:
$40.65
$31.39
$50.89
$63.72
| 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 87522 | ||||||
United | 87522 | $49.54 | 1346771128 - CYNTHIA COHEN | 264709927 - WESTCHESTER MEDICAL CENTER ADVANCED PHYSICIAN SERVICES, P.C | NY | Gastroenterology Physician (207RG0100X) |
United | 87522 | $69.31 | 1114421690 - KAVITHA VIJAYASEKAR | 453023019 - (NY) NORTH SHORE-LIJ MEDICAL PC | NY | Gastroenterology Physician (207RG0100X) |
United | 87522 | $26.22 | 1801812490 - ELLIOTT FUHRER | 113501514 - (NY) MAIMONIDES MEDICAL CENTER | NY | Gastroenterology Physician (207RG0100X) |
United | 87522 | $19.28 | 1841213014 - ROBERT WEISS | 132655001 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION | NY | Gastroenterology Physician (207RG0100X) |
United | 87522 | $25.70 | 1134283104 - HENRY KLOTZ | 113548772 - (NY) EMPIRE FAMILY MEDICINE PC | NY | Gastroenterology Physician (207RG0100X) |
United | 87522 | $22.21 | 1629333596 - ANISH PATEL | 465285330 - VALLEY PHYSICIAN SERVICES PC | NY | Gastroenterology Physician (207RG0100X) |
United | 87522 | $45.22 | 1831552165 - KEVIN YEROUSHALMI | 113265111 - (NY) PECONIC BAY PRIMARY MEDICAL CARE, P.C. | NY | Gastroenterology Physician (207RG0100X) |
United | 87522 | $93.61 | 1538328562 - RANDY LONGMAN | 131623978 | NY | Gastroenterology Physician (207RG0100X) |
United | 87522 | $17.98 | 1457318420 - JOSEPH TROMBA | 112534968 - (NY) LONG ISLAND GASTROENTEROLOGY, P.C. | NY | Gastroenterology Physician (207RG0100X) |
United | 87522 | $61.86 | 1255575262 - MATTHEW WARNDORF | 141338310 - ALBANY MEDICAL COLLEGE | NY | Gastroenterology Physician (207RG0100X) |
United | 87522 | $23.32 | 1750315628 - GABRIEL IONESCU | 562177958 - (NC) KURT VERNON MD PA | NY | Gastroenterology Physician (207RG0100X) |
United | 87522 | $29.93 | 1144751595 - MARC FENSTER | 542164621 - ST JOHNS MEDICAL SERVICES PC | NY | Gastroenterology Physician (207RG0100X) |
United | 87522 | $17.98 | 1164766325 - FLH MEDICAL, PC | 263765332 - (NY) FLH MEDICAL PC | NY | Gastroenterology Physician (207RG0100X) |
United | 87522 | $83.37 | 1801151907 - SULTAN MAHMOOD | 251727721 - UPMC | NY | Gastroenterology Physician (207RG0100X) |
United | 87522 | $17.98 | 1407915564 - JAHID AHAMED | 223877985 - (NY) HANSON PLACE PHYSICIAN ASSOCIATES PC | NY | Gastroenterology Physician (207RG0100X) |
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 87522 vs. Other Microbiology Procedures Codes
The CPT 87522 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 87522 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 87522. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87522 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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