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See a sample rate comparisonCPT 87631 Fee Schedule
Medicare rates as of January 2026
CPT 87631 is classified under Pathology and Laboratory Procedures, in the Microbiology Procedures subgroup.
Resp Virus 3 5 Targets, Infectious Agent Detection By Nucleic Acid Dna Or Rna Respiratory Virus Eg Adenovirus Influenza Virus Coronavirus Metapneumovirus Parainfluenza Virus Respiratory Syncytial Virus Rhinovirus Includes Multiplex Reverse Transcription When Performed And Multiplex Amplified Probe Technique Multiple Types Or Subtypes 3 5 Targets
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Microbiology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | QW - CLIA Waived Tests 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | $142.63 national lab fee schedule rate (2026) · View Medicare rates for 87631 |
| Medicaid Fee Schedule | $131.215 median of the 8 states in the free preview · View Medicaid rates for 87631 |
National average reimbursement for CPT 87631 by major payers:
$117.24
BCBS / Anthem
$93.87
UnitedHealthcare
$150.23
Aetna
$222.73
Cigna
Compare published rates across providers.
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CPT 87631
5 of 25 sample ratesHigher to lower in this preview
Tatyana Antonevich
Slocum Dickson Medical Group PLLC
$118.47Published rateAshley Fahy
Slocum Dickson Medical Group PLLC
$118.47Published rateStephen Eadline
Slocum Dickson Medical Group PLLC
$118.47Published rateTatyana Antonevich
Slocum Dickson Medical Group PLLC
$59.90Published rateElizabeth Cooley
Slocum Dickson Medical Group PLLC
$59.90Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 87631 vs. Other Microbiology Procedures Codes
The table lists codes related to 87631. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 87631-CPT | Low | Resp Virus 3 5 Targets, Infectious Agent Detection By Nucleic Acid Dna Or Rna Respiratory Virus Eg Adenovirus Influenza Virus Coronavirus Metapneumovirus Parainfluenza Virus Respiratory Syncytial Virus Rhinovirus Includes Multiplex Reverse Transcription When Performed And Multiplex Amplified Probe Technique Multiple Types Or Subtypes 3 5 Targets |
| 87632-CPT | Low | Resp Virus 6 11 Targets, Infectious Agent Detection By Nucleic Acid Dna Or Rna Respiratory Virus Eg Adenovirus Influenza Virus Coronavirus Metapneumovirus Parainfluenza Virus Respiratory Syncytial Virus Rhinovirus Includes Multiplex Reverse Transcription When Performed And Multiplex Amplified Probe Technique Multiple Types Or Subtypes 6 11 Targets |
| 87633-CPT | Moderate | Infectious Agent Detection By Nucleic Acid (Dna Or Rna); Respiratory Virus (Eg Adenovirus Influenza Virus Coronavirus Metapneumovirus Parainfluenza Virus Respiratory Syncytial Virus Rhinovirus) Includes Multiplex Reverse Transcription When Performed And Multiplex Amplified Probe Technique Multiple Types Or Subtypes 12-25 Targets (Desc Revised 01/01/15) |
| 87634-CPT | Low | Infectious Agent Detection By, Infectious Agent Detection By Nucleic Acid (Dna Orrna) Respiratory Syncytial Virus Amplified Prob E Technique Cancer Detection On Repeat Biopsy Hpa-9ab (V837m) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87631. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87631 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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Frequently Asked Questions
To find out the cost of a medical procedure, you can start by contacting your insurance provider directly. They can provide information on your coverage, deductibles, and estimated out-of-pocket costs. You can also ask your healthcare provider for an estimate. For specific, localized pricing information based on CPT codes, you can use tools like Payerprice.
CPT stands for Current Procedural Terminology. CPT codes are a set of medical codes used by physicians, allied health professionals, and other healthcare providers to report medical, surgical, and diagnostic procedures and services to entities such as health insurance companies. These codes standardize the reporting of healthcare services, making it easier to determine coverage and calculate costs across different providers and insurers. Knowing the CPT code for your procedure is crucial for accurately researching its cost.
You can often get an estimate from your healthcare provider or your insurance company. For a more direct search using a CPT code and specific location to find fee schedule information, you can utilize tools like Payerprice, which offers a lookup tool for this purpose.
Medical procedure costs can vary significantly due to several factors, including the specific healthcare provider or facility (e.g., hospital vs. outpatient clinic), geographic location, insurance negotiation rates, and the complexity of the procedure itself. Your insurance plan's deductible, co-pays, and co-insurance also play a major role in your out-of-pocket expenses.
Rarely does insurance cover the full cost of a procedure. Most insurance plans involve deductibles, co-pays, and co-insurance, which are amounts you are responsible for paying out-of-pocket. The extent of coverage depends on your specific plan benefits, whether the provider is in-network, and if the service is deemed medically necessary. It's best to contact your insurance provider directly for details on your specific coverage for a planned procedure.
If you receive an unexpected medical bill, first, review it carefully for accuracy, checking for duplicate charges or services you didn't receive. Next, contact your insurance company to understand what they covered and why. Then, reach out to the healthcare provider's billing department to dispute any discrepancies or to negotiate the bill. For understanding what typical costs might be for the services billed, you can use tools like Payerprice to research the fee schedule for specific CPT codes in your area.