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 |
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 | $15.28 | 1407947336 - CLHG-VILLE PLATTE LLC, MERCY REGIONAL MEDICAL CENTER | 824681222 | LA | General Acute Care Hospital (282N00000X) |
United | 87807 | $17.52 | 1225031495 - MONROE SURGICAL HOSPITAL, LLC | 721479756 - (LA) MONROE SURGICAL HOSPITAL | LA | General Acute Care Hospital (282N00000X) |
United | 87807 | $13.10 | 1063466035 - CHCA CLEAR LAKE LP, HCA HOUSTON HEALTHCARE CLEAR LAKE | 621801360 | TX | General Acute Care Hospital (282N00000X) |
United | 87807 | $13.10 | 1255384533 - COLUMBIA MEDICAL CENTER OF LEWISVILLE SUBSIDIARY LP, MEDICAL CITY LEWISVILLE | 621682210 - (TX) DE MARKETING AND SALES | TX | General Acute Care Hospital (282N00000X) |
United | 87807 | $14.84 | 1851487086 - FAIRWAY MEDICAL CENTER, LLC, AVALA | 721426390 - (LA) FAIRWAY MEDICAL CENTER, LLC DBA AVALA | LA | General Acute Care Hospital (282N00000X) |
United | 87807 | $13.10 | 1629021845 - ST DAVIDS HEALTHCARE PARTNERSHIP LP LLP, NORTH AUSTIN MEDICAL CENTER | 742781812 | TX | General Acute Care Hospital (282N00000X) |
United | 87807 | $13.10 | 1902857766 - COLUMBIA MEDICAL CENTER OF LAS COLINAS INC, MEDICAL CITY LAS COLINAS | 621650582 - (TX) COLUMBIA MEDICAL CENTER OF LAS COLINAS INC | TX | General Acute Care Hospital (282N00000X) |
United | 87807 | $13.10 | 1700801909 - TENET HOSPITALS LIMITED, THE HOSPITALS OF PROVIDENCE MEMORIAL CAMPUS | 954537720 | TX | General Acute Care Hospital (282N00000X) |
United | 87807 | $13.10 | 1932204427 - NMC OPERATING COMPANY LLC, THE SPINE HOSPITAL OF LOUISIANA | 270059959 - (LA) NMC OPERATING COMPANY, LLC | LA | General Acute Care Hospital (282N00000X) |
United | 87807 | $13.10 | 1891873337 - CLHG, MINDEN MEDICAL CENTER | 824625698 | LA | Rural Acute Care Hospital (282NR1301X) |
United | 87807 | $5.50 | 1487771705 - DONNA MEDICAL CLONIC | 223875437 - (TX) DONNA MEDICAL CLINIC, P.A. | 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 | $5.50 | 1992720791 - OMEGA HOSPITAL LLC | 470901008 - (LA) OMEGA HOSPITAL, LLC | LA | General Acute Care Hospital (282N00000X) |
United | 87807 | $7.86 | 1295736734 - CHRISTUS HEALTH ARK-LA-TEX, CHRISTUS ST. MICHAEL HEALTH SYSTEM | 752616977 - CHRISTUS TRINITY CLINIC | TX | General Acute Care Hospital (282N00000X) |
United | 87807 | $13.10 | 1326546797 - HENDERSON HOSPITAL, LLC, UTHEALTH EAST TEXAS HENDERSON HOSPITAL | 824019349 | 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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