CPT 87809 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 | Infectious Agent Antigen Detection Microbiology Procedures |
| Common Place of Service | 20 - Urgent Care Facility 11 - Office 17 - Walk-in Retail Health Clinic |
| Common Modifiers | None QW - CLIA Waived Tests RT - Right side of body |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 87809 |
National average reimbursement for CPT 87809 by major payers:
$17.24
$11.93
$19.36
$55.59
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 87809 | $13.06 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 87809 | $7.61 | 1598375651 - E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC, E AND A HEALTHCARE ON THE GO | 832289173 - (FL) E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC | FL | Home Health Agency (251E00000X) |
United | 87809 | $13.06 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 87809 | $11.98 | 1255478004 - CHRISTOPHER RAIO | 111635088 - MERCY MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 87809 | $13.06 | 1255478004 - CHRISTOPHER RAIO | 208243412 - SAMARITAN EMERGENCY MEDICAL SERVICES PC | NY | Emergency Medicine Physician (207P00000X) |
United | 87809 | $6.90 | 1609823194 - SACRED HEART HEALTH SYSTEM INC, SACRED HEART HOME CARE | 590634434 - SACRED HEART HEALTH SYSTEM INC | FL | Home Health Agency (251E00000X) |
United | 87809 | $9.14 | 1083903744 - HOSPITAL SERVICE DISTRICT OF THE PARISH OF ST. BERNARD, STATE OF LOUIS, ST. BERNARD PARISH HOSPITAL | 261576974 - (LA) HOSPITAL SERVICE DISTRICT OF THE PARISH OF ST BERNARD STATE OF LOUIS | LA | Rural Acute Care Hospital (282NR1301X) |
United | 87809 | $28.23 | 1437126745 - ALAN MELTZER | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | Pediatrics Physician (208000000X) |
United | 87809 | $7.61 | 1598375651 - E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC, E AND A HEALTHCARE ON THE GO | 832289173 - (FL) E AND A MEDICAL ON THE GO HEALTHCARE OF SOUTH FLORIDA LLC | FL | Home Health Agency (251E00000X) |
United | 87809 | $5.36 | 1588098172 - PROGRESSIVE EMERGENCY PHYSICIANS PLLC | 463316332 - PROGRESSIVE EMERGENCY PHYSICIANS PLLC | NY | Multi-Specialty Group (193200000X) |
United | 87809 | $16.01 | 1619910627 - BRADLEY WEISNER | 562107759 - UROLOGY SPECIALISTS OF THE CAROLINAS, PLLC | NC | Urology Physician (208800000X) |
United | 87809 | $11.98 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 87809 | $7.04 | 1730106824 - NEVADA EYE CARE PROFESSIONALS LITTLE & STEIN, LTD. | 880316581 - NEVADA EYE CARE PROFESSIONALS | NV | Ophthalmology Physician (207W00000X) |
United | 87809 | $25.85 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | 87809 | $9.14 | 1003166612 - MATTHEW LILLEY | 931261079 - THE ORTHOPEDIC AND NEUROSURGICAL CENTER OF THE CASCADES | OR | Orthopaedic Surgery Physician (207X00000X) |
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 87809 vs. Other Microbiology Procedures Codes
The CPT 87809 code is part of the Infectious Agent Antigen Detection 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 87809 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 | Test Of Infection Type, This Test Identifies The Cause Of An Infection (Bacteria Or Virus) By Isolating And Identifying Its Genetic Signature (Dna). Sample Material Can Be Taken From Stool Mucus Or Other Body Fluid. |
| 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 |
| 87809-CPT | Low | Test For Adenovirus Infection, The Test Detects Adenovirus A Lung Infection. The Virus Causes Lymph Nodes At The Back Of The Throat To Become Enlarged Which Can Make Breathing Difficult. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87809. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87809 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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