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See a sample rate comparisonCPT 87804 Fee Schedule
Last Verified: October 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 For Flu Virus, Influenza (Flu) Is A Viral Infection Of The Lungs That Causes Fever Cough And Muscle Aches. The Test Checks A Sample From The Nose Or Throat For Influenza A B Or Both Types.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Microbiology Procedures |
| Common Place of Service | 20 - Urgent Care Facility 11 - Office |
| Common Modifiers | QW - CLIA Waived Tests None 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 87804 |
| Medicaid Fee Schedule | View Medicaid rates for 87804 |
National average reimbursement for CPT 87804 by major payers:
$15.39
$15.18
$17.39
$23.55
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CPT 87804
5 of 25 sample ratesHigher to lower in this preview
Abbas Ali
$30.94Published rateMaher M Ayoubi, Md, LLC
$14.00Published rateRichard Prewitt
$14.00Published rateKaran Munuswamy
$14.00Published rateNathaniel Valin
$8.27Published rate
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See a sample payer proposalCPT 87804 vs. Other Microbiology Procedures Codes
The CPT 87804 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 87804 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 |
|---|---|---|
| 87802-CPT | Low | Infectious Agent Antigen Detec, Infectious Agent Antigen Detection By Immunoassay With Direct Optical (Ie Visual) Observation Streptococcus Group B |
| 87803-CPT | Low | Test For Intestinal Infection, The Test Detects Toxins Produced By Clostridium Difficile Bacteria Which Causes Diarrhea And Usually Results From Antibiotic Use. |
| 87804-CPT | Low | Test For Flu Virus, Influenza (Flu) Is A Viral Infection Of The Lungs That Causes Fever Cough And Muscle Aches. The Test Checks A Sample From The Nose Or Throat For Influenza A B Or Both Types. |
| 87806-CPT | Low | Hiv Ag W Hiv1 2 Antb W Optic, Infectious Agent Antigen Detection By Immunoassay With Direct Optical Ie Visual Observation Hiv 1 Antigen S With Hiv 1 And Hiv 2 Antibodies |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87804. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87804 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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