CPT 87800 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 | • Pathology and Laboratory Procedures • Microbiology Procedures |
| Common Place of Service | • 11 - Office • 81 - Independent Laboratory |
| Common Modifiers | • None • QW - CLIA Waived Tests • 59 - Distinct Procedural Service |
| Complexity Level | Low |
National average reimbursement for CPT 87800 by major payers:
$41.27
$30.40
$45.14
$63.45
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 87800 | ||||||
United | 87800 | $26.20 | 1548260482 - MAIN LINE PATHOLOGY ASSOCIATES, PC | 232786651 - (PA) MAIN LINE PATHOLOGY ASSOCIATES, P.C | PA | Clinical Pathology/Laboratory Medicine Physician (207ZP0105X) |
United | 87800 | $33.61 | 1962024026 - CLHG-RUSTON LLC | 844422249 | LA | General Acute Care Hospital (282N00000X) |
United | 87800 | $49.25 | 1265437644 - WEST JEFFERSON HOLDINGS, LLC, WEST JEFFERSON MEDICAL CENTER | 472667968 - WEST JEFFERSON HOLDINGS, LLC | LA | General Acute Care Hospital (282N00000X) |
United | 87800 | $43.66 | 1437102639 - COLUMBIA MEDICAL CENTER OF MCKINNEY SUBSIDIARY LP, MEDICAL CITY MCKINNEY | 621682207 - (TX) COLUMBIA MEDICAL CENTER OF MCKINNEY SUBSIDIARY LP | TX | General Acute Care Hospital (282N00000X) |
United | 87800 | $22.97 | 1669480323 - KELL WEST REGIONAL HOSPITAL LLC | 752756307 - KELL WEST REGIONAL HOSPITAL, LLC | TX | General Acute Care Hospital (282N00000X) |
United | 87800 | $18.71 | 1689650921 - EASTLAND MEMORIAL HOSPITAL DISTRICT, EASTLAND MEMORIAL HOSPITAL | 752313255 | TX | General Acute Care Hospital (282N00000X) |
United | 87800 | $43.66 | 1649223645 - ST DAVIDS HEALTHCARE PARTNERSHIP LP LLP, ROUND ROCK MEDICAL CENTER | 742781812 | TX | General Acute Care Hospital (282N00000X) |
United | 87800 | $67.23 | 1972517365 - COVENANT MEDICAL CENTER | 822913146 - (TX) COVENANT MEDICAL CENTER | TX | General Acute Care Hospital (282N00000X) |
United | 87800 | $43.66 | 1568461572 - WILLIS KNIGHTON MEDICAL CENTER, INC. | 720400933 - (LA) WILLIS-KNIGHTON MEDICAL CENTER | LA | General Acute Care Hospital (282N00000X) |
United | 87800 | $15.72 | 1568848059 - CUMBERLAND SURGICAL HOSPITAL OF SAN ANTONIO LLC, LEGENT ORTHOPEDIC & SPINE | 474612520 | TX | General Acute Care Hospital (282N00000X) |
United | 87800 | $43.66 | 1407191984 - BSA HOSPITAL LLC | 300754305 | TX | General Acute Care Hospital (282N00000X) |
United | 87800 | $84.05 | 1477516466 - SCOTT & WHITE MEMORIAL HOSPITAL, BAYLOR SCOTT & WHITE MEDICAL CENTER - TEMPLE | 742958277 - SCOTT & WHITE CLINIC | TX | General Acute Care Hospital (282N00000X) |
United | 87800 | $43.66 | 1457994188 - VHS HARLINGEN HOSPITAL COMPANY, LLC, VALLEY BAPTIST MICRO-HOSPITAL WESLACO | 452662980 | TX | General Acute Care Hospital (282N00000X) |
United | 87800 | $43.66 | 1629021845 - ST DAVIDS HEALTHCARE PARTNERSHIP LP LLP, NORTH AUSTIN MEDICAL CENTER | 742781812 | TX | General Acute Care Hospital (282N00000X) |
United | 87800 | $43.66 | 1396129201 - UNION MEDICAL CENTER, UNION MEDICAL CENTER | 474491361 | SC | General Acute Care Hospital (282N00000X) |
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 87800 vs. Other Microbiology Procedures Codes
The CPT 87800 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 87800 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 | Nucleic Acid Detection; Herpes Virus-6, Quantification |
| 87534-CPT | Low | Nucleic Acid Detection; Hiv-1, Direct Probe Technique |
| 87535-CPT | Low | Infectious Agent Detection By Nucleic Acid (Dna Orrna); Hiv-1 Amplified Probe Technique Includes Reverse Transcription When Performed (Revised 01/01/2014) |
| 87800-CPT | Low | Nucleic Acid Detection, Multiple Organisms; Direct Probe(S) Technique |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87800. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87800 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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