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See a sample rate comparisonHealthcare 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 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 87529 |
| Medicaid Fee Schedule | View Medicaid rates for 87529 |
National average reimbursement for CPT 87529 by major payers:

$32.61

$25.54

$38.88

$50.93
Choose a payer to see a sample of rates for CPT 87529.
Merrimack Valley Pediatric Associates, Inc.
Merrimack Valley Pediatric Associates, Inc.
Prisma Health - Upstate
Good Samaritan Hosptial Medical Center
The Orthopedic And Neurosurgical Center Of The Cascades
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Rate Benchmarking
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See a sample rate comparisonPayer Contract Negotiation
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See a sample payer proposalCPT 87529 vs. Other Microbiology Procedures Codes
The CPT 87529 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 87529 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 |
|---|---|---|
| 87525-CPT | Low | Test For Hepatitis G Virus, Hepatitis G Is A Virus That Can Damage The Liver. This Blood Test Detects Hepatitis G Genetic Material. The Test Is Used To Verify A Current Infection Or Monitor Response To Treatment. |
| 87528-CPT | Low | Test For Herpes Simplex Virus, The Test Detects The Herpes Simplex Virus (Hsv). If Hsv Is Present It Is Identified As Type 1 Or Type 2. The Test Sample Can Be Blood Tissue Or Fluid From A Herpes Blister. |
| 87529-CPT | Low | Test For Herpes Simplex Virus, The Test Detects The Herpes Simplex Virus (Hsv). If Hsv Is Present It Is Identified As Type 1 Or Type 2. The Test Sample Can Be Blood Tissue Or Fluid From A Herpes Blister. |
| 87530-CPT | Low | Test For Herpes Simplex Virus, The Test Detects The Herpes Simplex Virus (Hsv). If Hsv Is Present It Is Identified As Type 1 Or Type 2. The Test Sample Can Be Blood Tissue Or Fluid From A Herpes Blister. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87529. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87529 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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