CPT 87807 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 • 20 - Urgent Care Facility |
| Common Modifiers | • None • QW - CLIA Waived Tests • 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 87807 |
National average reimbursement for CPT 87807 by major payers:
$11.87
$9.14
$14.97
$47.25
| 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 87807 | ||||||
United | 87807 | $5.59 | 1689650921 - EASTLAND MEMORIAL HOSPITAL DISTRICT, EASTLAND MEMORIAL HOSPITAL | 752313255 | TX | General Acute Care Hospital (282N00000X) |
United | 87807 | $4.71 | 1568801116 - VICTORY MEDICAL CENTER LANDMARK, LP | 474612520 | TX | General Acute Care Hospital (282N00000X) |
United | 87807 | $16.44 | 1588654966 - ST. JAMES PARISH HOSP. SERV. DIST. | 726010747 - (LA) ST JAMES PARISH HOSPITAL | LA | Critical Access Hospital (282NC0060X) |
United | 87807 | $11.78 | 1942294939 - ST JOSEPH REGIONAL HEALTH CENTER, ST JOSEPH AMBULATORY SURGERY | 741282696 - ST JOSEPH REGIONAL HEALTH CENTER | TX | General Acute Care Hospital (282N00000X) |
United | 87807 | $13.10 | 1689628984 - COLUMBIA HOSPITAL AT MEDICAL CITY DALLAS SUBSIDIARY LP, MEDICAL CITY DALLAS | 621682198 | TX | General Acute Care Hospital (282N00000X) |
United | 87807 | $13.10 | 1952538431 - METHODIST MCKINNEY HOSPITAL LLC | 208847736 - (TX) METHODIST MCKINNEY HOSPITAL LLC | TX | General Acute Care Hospital (282N00000X) |
United | 87807 | $7.03 | 1649224825 - JONES COUNTY REGIONAL HEALTHCARE SYSTEM, STAMFORD MEMORIAL HOSPITAL | 461285811 - (TX) JONES COUNTY REGIONAL HEALTHCARE SYSTEM | TX | General Acute Care Hospital (282N00000X) |
United | 87807 | $11.78 | 1083661409 - LALLIE KEMP MEDICAL CTR, LALLIE KEMP REGIONAL MEDICAL CENTER | 726000749 | LA | Critical Access Hospital (282NC0060X) |
United | 87807 | $15.28 | 1407947336 - CLHG-VILLE PLATTE LLC, MERCY REGIONAL MEDICAL CENTER | 824681222 | LA | General Acute Care Hospital (282N00000X) |
United | 87807 | $13.10 | 1730730490 - US HEALTH PARTNERS, LLC | 843119330 - (TX) US HEALTH PARTNERS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 87807 | $13.10 | 1205189172 - EMERUS BHS SA THOUSAND OAKS, LLC, BAPTIST NEIGHBORHOOD HOSPITAL OVERLOOK | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 87807 | $13.10 | 1649223645 - ST DAVIDS HEALTHCARE PARTNERSHIP LP LLP, ROUND ROCK MEDICAL CENTER | 742781812 | TX | General Acute Care Hospital (282N00000X) |
United | 87807 | $15.18 | 1669480323 - KELL WEST REGIONAL HOSPITAL LLC | 752756307 - KELL WEST REGIONAL HOSPITAL, LLC | TX | General Acute Care Hospital (282N00000X) |
United | 87807 | $13.10 | 1871911016 - NORTH TEXAS, MEDICAL CITY ALLIANCE | 464027347 - (TX) NORTH TEXAS | TX | General Acute Care Hospital (282N00000X) |
United | 87807 | $13.10 | 1639422504 - EMERUS BHS SA THOUSAND OAKS, LLC, BAPTIST NEIGHBORHOOD HOSPITAL SCHERTZ | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | 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 87807 vs. Other Microbiology Procedures Codes
The CPT 87807 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 87807 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 |
|---|---|---|
| 87801-CPT | Low | Nucleic Acid Detection, Multiple Organisms; Amplified Probe(S) Techniq |
| 87804-CPT | Low | Infectious Agent Antigen Detection By Immunoassay With Direct Optical (Ie Visual) Observation; Influenza (Desc Rvsd 10/6/20) |
| 87806-CPT | Low | Infectious Agent Antigen Detection By Immunoassay With Direct Optical (Ie Visual) Observation; Hiv-1 Antigen(S) With Hiv-1 And Hiv-2 Antibodies (Desc Rvsd 10/6/20) |
| 87807-CPT | Low | Infectious Agent Antigen Detection By Immunoassay With Direct Optical (Ie Visual) Observation; Respiratory Syncytial Virus (Desc Rvsd 10/6/20) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87807. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87807 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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