CPT 87806 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 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 87806 |
| Medicaid Fee Schedule | View Medicaid rates for 87806 |
National average reimbursement for CPT 87806 by major payers:
$27.63
$19.55
$31.34
$67.16
CPT 87806 vs. Other Microbiology Procedures Codes
The CPT 87806 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 87806 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 |
|---|---|---|
| 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 |
| 87807-CPT | Low | Infectious Agent Antigen Detec, Infectious Agent Antigen Detection By Immunoassay With Direct Optical (Ie Visual) Observation Respiratory Syncytial Virus |
| 87901-CPT | Moderate | Test Antiviral Drug Resistance, This Test Evaluates Whether Or How Much Resistance The Hiv Virus May Have Developed To One Or More Drugs Or Drug Combinations. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87806. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87806 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 87806) and we'll show you how you compare in 15 minutes or less.