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See a sample rate comparisonCPT 87797 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 Of Infection Type, This Test Identifies The Cause Of An Infection (Bacteria Or Virus) By Isolating And Identifying Its Genetic Signature (Dna). Sample Material Can Be Taken From Stool Mucus Or Other Body Fluid.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Microbiology Procedures |
| Common Place of Service | 11 - Office 81 - Independent Laboratory |
| Common Modifiers | None 59 - Distinct Procedural Service 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 87797 |
| Medicaid Fee Schedule | View Medicaid rates for 87797 |
National average reimbursement for CPT 87797 by major payers:
$27.16
$17.49
$27.90
$42.04
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CPT 87797
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$66.07Published rateLubbock Heritage Hospital, LLC., Grace Surgical Hospital
Lubbock Heritage Hospital LLC
$33.61Published rateOur Lady Of Lourdes Regional Medical Center,Inc
Our Lady Of Lourdes Regional Medical Center Inc
$30.03Published rateBrittany Ptachick
Hroa 401k Plan
$12.61Published rateMolly Mcintosh
Baycare Medical Group Inc
$7.34Published rate
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See a sample payer proposalCPT 87797 vs. Other Microbiology Procedures Codes
The CPT 87797 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 87797 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) |
| 87797-CPT | Low | Test Of Infection Type, This Test Identifies The Cause Of An Infection (Bacteria Or Virus) By Isolating And Identifying Its Genetic Signature (Dna). Sample Material Can Be Taken From Stool Mucus Or Other Body Fluid. |
| 87798-CPT | Low | Test Of Infection Type, This Test Identifies The Cause Of An Infection (Bacteria Or Virus) By Isolating And Identifying Its Genetic Signature (Dna). Sample Material Can Be Taken From Stool Mucus Or Other Body Fluid. |
| 87799-CPT | Low | Test Of Infection Type, This Test Identifies The Cause Of An Infection (Bacteria Or Virus) By Isolating And Identifying Its Genetic Signature (Dna). Sample Material Can Be Taken From Stool Mucus Or Other Body Fluid. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87797. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87797 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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