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See a sample rate comparisonCPT 87538 Fee Schedule
Last Verified: September 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.
Hiv 2 Probe Revrse Trnscripj, Infectious Agent Detection By Nucleic Acid Dna Or Rna Hiv 2 Amplified Probe Technique Includes Reverse Transcription When Performed
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Microbiology Procedures |
| Common Place of Service | 81 - Independent Laboratory 71 - Public Health Clinic |
| Common Modifiers | None 90 - Reference Laboratory 33 - Preventive Services |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 87538 |
| Medicaid Fee Schedule | View Medicaid rates for 87538 |
National average reimbursement for CPT 87538 by major payers:
$33.36
$25.22
$38.71
$52.06
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CPT 87538
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$77.20Published ratePelham Medical Center
$35.09Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$30.13Published rateAaron Askew
Desert Bone & Joint Specialists, LLP
$20.08Published rateBrittany Ptachick
Hroa 401k Plan
$14.74Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 87538 vs. Other Microbiology Procedures Codes
The CPT 87538 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 87538 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 |
|---|---|---|
| 87534-CPT | Low | Infectious Agent Detection By, Infectious Agent Detection By Nucleic Acid (Dna Orrna)Hiv-1 Direct Probe Technique Infectious Ag Ent Detection By Nucleic Acid (Dna Or Rna) |
| 87536-CPT | Low | Infectious Agent Detection By, Infectious Agent Detection By Nucleic Acid (Dna Orrna)Hiv-1 Quantification Infectious Agent Dete Ction By Nucleic Acid (Dna Or Rna) |
| 87538-CPT | Low | Hiv 2 Probe Revrse Trnscripj, Infectious Agent Detection By Nucleic Acid Dna Or Rna Hiv 2 Amplified Probe Technique Includes Reverse Transcription When Performed |
| 87539-CPT | Low | Infectious Agent Detection By, Infectious Agent Detection By Nucleic Acid (Dna Orrna)Hiv-2 Quantification Infectious Agent Dete Ction By Nucleic Acid (Dna Or Rna) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87538. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87538 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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