CPT 87798 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 59 - Distinct Procedural Service 90 - Reference Laboratory |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 87798 |
National average reimbursement for CPT 87798 by major payers:
$32.28
$23.87
$40.78
$50.97
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 87798 | $31.57 | 1811237985 - PRISMA HEALTH-MIDLANDS, PRISMA HEALTH BAPTIST PARKRIDGE HOSPITAL | 582296052 - (SC) PRISMA HEALTH-MIDLANDS | SC | General Acute Care Hospital (282N00000X) |
United | 87798 | $35.09 | 1568818417 - METHODIST HOSPITALS OF DALLAS, METHODIST SOUTHLAKE MEDICAL CENTER | 750800661 - METHODIST HOSPITALS OF DALLAS | TX | General Acute Care Hospital (282N00000X) |
United | 87798 | $20.60 | 1447259627 - TYLER COUNTY HOSPITAL DISTRICT | 746067306 | TX | General Acute Care Hospital (282N00000X) |
United | 87798 | $31.57 | 1043392491 - DOCTORS' HOSPITAL OF SLIDELL, LLC, STERLING SURGICAL HOSPITAL | 522363244 - (LA) DOCTORS HOSPITAL OF SLIDELL, LLC | LA | General Acute Care Hospital (282N00000X) |
United | 87798 | $31.57 | 1942294939 - ST JOSEPH REGIONAL HEALTH CENTER, ST JOSEPH AMBULATORY SURGERY | 741282696 - ST JOSEPH REGIONAL HEALTH CENTER | TX | General Acute Care Hospital (282N00000X) |
United | 87798 | $35.09 | 1114998911 - GRANBURY HOSPITAL CORPORATION, LAKE GRANBURY MEDICAL CENTER | 752682017 - (TX) GRANBURY HOSPITAL CORPORATION | TX | General Acute Care Hospital (282N00000X) |
United | 87798 | $12.63 | 1568848059 - CUMBERLAND SURGICAL HOSPITAL OF SAN ANTONIO LLC, LEGENT ORTHOPEDIC & SPINE | 474612520 | TX | General Acute Care Hospital (282N00000X) |
United | 87798 | $35.09 | 1144274226 - NAVARRO HOSPITAL LP, NAVARRO REGIONAL HOSPITAL | 621762428 | TX | General Acute Care Hospital (282N00000X) |
United | 87798 | $35.09 | 1861994808 - HCN EP HORIZON CITY, LLC, THE HOSPITALS OF PROVIDENCE NORTHEAST CAMPUS | 813935393 - (TX) HCN EP HORIZON CITY LLC | TX | General Acute Care Hospital (282N00000X) |
United | 87798 | $44.13 | 1245878990 - HUNTSVILLE COMMUNITY HOSPITAL, INC. | 843654542 - (TX) HUNTSVILLE COMMUNITY HOSPITAL INC | TX | General Acute Care Hospital (282N00000X) |
United | 87798 | $35.09 | 1609807122 - SPARTANBURG MEDICAL CENTER | 576000934 | SC | General Acute Care Hospital (282N00000X) |
United | 87798 | $65.00 | 1942208616 - ST. LUKE'S COMMUNITY HEALTH SERVICES, ST. LUKE'S THE WOODLANDS HOSPITAL | 760536234 - (TX) ST LUKES COMMUNITY HEALTH SERVICES | TX | General Acute Care Hospital (282N00000X) |
United | 87798 | $35.09 | 1609860360 - OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL, ASSUMPTION COMMUNITY HOSPITAL | 721495500 - (LA) OUR LADY OF THE LAKE ASSUMPTION COMMUNITY HOSPITAL INC | LA | Rural Acute Care Hospital (282NR1301X) |
United | 87798 | $16.37 | 1770573586 - MCALLEN HOSPITALS L P, SOUTH TEXAS HEALTH SYSTEM | 233069260 | TX | General Acute Care Hospital (282N00000X) |
United | 87798 | $30.15 | 1013068808 - ST HELENA PARISH HOSPITAL, ST HELENA PARISH HOSPITAL | 720627145 - (LA) ST HELENA PARISH HOSPITAL | 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 87798 vs. Other Microbiology Procedures Codes
The CPT 87798 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 87798 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. |
| 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) |
| 87535-CPT | Low | Hiv 1 Probe Reverse Trnscrpj, Infectious Agent Detection By Nucleic Acid Dna Or Rna Hiv 1 Amplified Probe Technique Includes Reverse Transcription When Performed |
| 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. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87798. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87798 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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