CPT 87635 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 | Infectious Agent Antigen Detection Microbiology Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | None QW - CLIA Waived Tests 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 87635 |
National average reimbursement for CPT 87635 by major payers:
$55.10
$41.76
$61.16
$69.14
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 87635 | $30.79 | 1306843826 - WEST CARROLL HEALTH SYSTEMS LLC, WEST CARROLL MEMORIAL HOSPITAL | 562300247 - WEST CARROLL HEALTH SYSTEMS L.L.C. | LA | General Acute Care Hospital (282N00000X) |
United | 87635 | $46.18 | 1265437644 - WEST JEFFERSON HOLDINGS, LLC, WEST JEFFERSON MEDICAL CENTER | 472667968 - WEST JEFFERSON HOLDINGS, LLC | LA | General Acute Care Hospital (282N00000X) |
United | 87635 | $30.79 | 1316936990 - EL PASO COUNTY HOSPITAL DISTRICT, UNIVERSITY MEDICAL CENTER OF EL PASO | 752668018 | TX | General Acute Care Hospital (282N00000X) |
United | 87635 | $51.31 | 1558311936 - TEMPLE VAMC | 742791419 | TX | General Acute Care Hospital (282N00000X) |
United | 87635 | $30.79 | 1720033947 - ST. DAVIDS HEALTHCARE PARTNERSHIP, L.P., LLP, HEART HOSPITAL OF AUSTIN | 743001674 - (TX) LONE STAR CIRCLE OF CARE | TX | General Acute Care Hospital (282N00000X) |
United | 87635 | $30.79 | 1407191984 - BSA HOSPITAL LLC | 300754305 | TX | General Acute Care Hospital (282N00000X) |
United | 87635 | $30.79 | 1306843826 - WEST CARROLL HEALTH SYSTEMS LLC, WEST CARROLL MEMORIAL HOSPITAL | 562300247 - WEST CARROLL HEALTH SYSTEMS L.L.C. | LA | General Acute Care Hospital (282N00000X) |
United | 87635 | $43.61 | 1679557888 - CHRISTUS HEALTH SOUTHEAST TEXAS, CHRISTUS SOUTHEAST TEXAS - ST. ELIZABETH | 760591590 - (TX) CHRISTUS HEALTH SOUTHEAST TEXAS | TX | General Acute Care Hospital (282N00000X) |
United | 87635 | $30.79 | 1942294939 - ST JOSEPH REGIONAL HEALTH CENTER, ST JOSEPH AMBULATORY SURGERY | 741282696 - ST JOSEPH REGIONAL HEALTH CENTER | TX | General Acute Care Hospital (282N00000X) |
United | 87635 | $30.79 | 1942294939 - ST JOSEPH REGIONAL HEALTH CENTER, ST JOSEPH AMBULATORY SURGERY | 741282696 - ST JOSEPH REGIONAL HEALTH CENTER | TX | General Acute Care Hospital (282N00000X) |
United | 87635 | $51.31 | 1093793408 - JACKSON PARISH HOSPITAL, JACKSON PARISH HOSPITAL | 720549907 | LA | Critical Access Hospital (282NC0060X) |
United | 87635 | $51.31 | 1568461572 - WILLIS KNIGHTON MEDICAL CENTER, INC. | 720400933 - (LA) WILLIS-KNIGHTON MEDICAL CENTER | LA | General Acute Care Hospital (282N00000X) |
United | 87635 | $51.31 | 1568818417 - METHODIST HOSPITALS OF DALLAS, METHODIST SOUTHLAKE MEDICAL CENTER | 750800661 - METHODIST HOSPITALS OF DALLAS | TX | General Acute Care Hospital (282N00000X) |
United | 87635 | $21.54 | 1770573586 - MCALLEN HOSPITALS L P, SOUTH TEXAS HEALTH SYSTEM | 233069260 | TX | General Acute Care Hospital (282N00000X) |
United | 87635 | $21.54 | 1235177320 - BIENVILLE MEDICAL CENTER, INC. | 743227578 | LA | Critical Access Hospital (282NC0060X) |
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 87635 vs. Other Microbiology Procedures Codes
The CPT 87635 code is part of the Infectious Agent Antigen Detection 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 87635 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 |
|---|---|---|
| 87533-CPT | Low | Test Human Herpesvirus 6, The Test Detects Infection With Human Herpes Virus-6 Which Causes Roseola In Children. The Virus Causes Lung Liver And Brain Infections In People With Weak Immune Systems. |
| 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 |
| 87635-CPT | Low | Sars Cov 2 Covid 19 Amp Prb, Infectious Agent Detection By Nucleic Acid Dna Or Rna Severe Acute Respiratory Syndrome Coronavirus 2 Sars Cov 2 Coronavirus Disease Covid 19 Amplified Probe Technique |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87635. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87635 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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