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See a sample rate comparisonCPT 87809 Fee Schedule
Last Verified: September 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 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.
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures 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 |
| Medicaid Fee Schedule | View Medicaid rates for 87809 |
National average reimbursement for CPT 87809 by major payers:
$17.24
$11.93
$19.36
$55.59
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CPT 87809
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$47.87Published rateAhs Hospital Corp
Atlantic Health System Inc
$22.20Published rateChristopher Raio
Samaritan Emergency Medical Services PC
$13.06Published rateHospital Service District Of The Parish Of St. Bernard, State Of Louis, St. Bernard Parish Hospital
Hospital Service District Of The Parish Of St Bernard State Of Louis
$9.14Published rateProgressive Emergency Physicians PLLC
$5.36Published rate
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See a sample payer proposalCPT 87809 vs. Other Microbiology Procedures Codes
The CPT 87809 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 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. |
| 87807-CPT | Low | Infectious Agent Antigen Detec, Infectious Agent Antigen Detection By Immunoassay With Direct Optical (Ie Visual) Observation Respiratory Syncytial Virus |
| 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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