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See a sample rate comparisonCPT 87561 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.
Test Atypical Tuberculosis, The Test Detects Infection With Mycobacterium Avium-Intracellulare A Type Of Bacteria That Usually Affects The Lungs Or Intestines.
| 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 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 87561 |
| Medicaid Fee Schedule | View Medicaid rates for 87561 |
National average reimbursement for CPT 87561 by major payers:
$33.00
$25.22
$36.26
$50.94
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CPT 87561
5 of 25 sample ratesHigher to lower in this preview
Christopher Raio
Mercy Medical Center
$46.32Published ratePrisma Health-Upstate, Prisma Health Hillcrest Hospital Vascular Lab
Prisma Health - Upstate
$31.57Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$30.13Published rateAaron Askew
Desert Bone & Joint Specialists, LLP
$20.08Published rateBsa Hospital LLC
$14.73Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 87561 vs. Other Microbiology Procedures Codes
The CPT 87561 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 87561 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) |
| 87560-CPT | Low | Infectious Agent Detection By, Infectious Agent Detection By Nucleic Acid (Dna Orrna)Mycobacteria Avium-Intracellulare Direct Pr Obe Technique Infectious Agent Detection By Nucleic Acid (Dna Or Rna) |
| 87561-CPT | Low | Test Atypical Tuberculosis, The Test Detects Infection With Mycobacterium Avium-Intracellulare A Type Of Bacteria That Usually Affects The Lungs Or Intestines. |
| 87562-CPT | Low | Infectious Agent Detection By, Infectious Agent Detection By Nucleic Acid (Dna Orrna)Mycobacteria Avium-Intracellulare Quantific Ation Infectious Agent Detection 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 87561. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87561 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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