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See a sample rate comparisonCPT 87811 Fee Schedule
Last Verified: October 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.
Infectious Agent Antigen Detec, Infectious Agent Antigen Detection By Immunoassay With Direct Optical (Ie Visual) Observation Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19])
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Microbiology Procedures |
| Common Place of Service | 20 - Urgent Care Facility 11 - Office 81 - Independent Laboratory |
| Common Modifiers | QW - CLIA Waived Tests 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | $41.38 national lab fee schedule rate (2026) · View Medicare rates for 87811 |
| Medicaid Fee Schedule | $38.07 median of the 8 states in the free preview · View Medicaid rates for 87811 |
National average reimbursement for CPT 87811 by major payers:
$35.66
$36.02
$48.48
$62.58
Compare published rates across providers.
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CPT 87811
5 of 25 sample ratesHigher to lower in this preview
Morna Dorsey
$336.39Published rateJay Jin
Indiana Clinic Critical Care LLC
$50.45Published ratePatrick Klemawesch
Allergy Associates Stephen J. Klemawesch, Md, PA
$32.33Published ratePaul Schkade
Boulder Valley Asthma And Allergy Clinics, P.C.
$27.50Published ratePrinceton Allergy & Asthma Associates, PA
Princeton Allergy & Asthma Associates, P.A.
$24.82Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 87811 vs. Other Microbiology Procedures Codes
The CPT 87811 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 87811 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. |
| 87807-CPT | Low | Infectious Agent Antigen Detec, Infectious Agent Antigen Detection By Immunoassay With Direct Optical (Ie Visual) Observation Respiratory Syncytial Virus |
| 87811-CPT | Low | Infectious Agent Antigen Detec, Infectious Agent Antigen Detection By Immunoassay With Direct Optical (Ie Visual) Observation Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]) |
| 87913-CPT | Moderate | Nfct Agt Gntyp Alys Sarscov2, Infectious Agent Genotype Analysis By Nucleic Acid (Dna Or Rna); Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) (Coronavirus Disease [Covid-19]) Mutation Identification In Targeted Region(S) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87811. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87811 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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Frequently Asked Questions
To find the estimated cost of a medical procedure, you should ideally have the CPT (Current Procedural Terminology) code for the service and your specific location. With this information, you can use tools like Payerprice's fee schedule lookup. Payerprice allows you to search with a CPT code and location to access fee schedule data, helping you understand potential costs before your procedure.
A CPT (Current Procedural Terminology) code is a five-digit numerical code used by healthcare providers to describe medical, surgical, and diagnostic services. It is crucial for understanding costs because it standardizes the description of services across the healthcare industry. When looking up prices on platforms like Payerprice, using the correct CPT code ensures you are searching for the exact service you need, providing accurate fee schedule information specific to that procedure and your location.
For specific estimates on healthcare services, especially if you know the CPT code and your location, Payerprice offers a valuable fee schedule lookup tool. This tool enables users to search for prices based on these details, providing insights into what different payers might reimburse for a given service. This can help you anticipate out-of-pocket costs and make informed decisions.
In-network costs typically refer to services received from providers who have a contract with your insurance company. These services are often covered at a higher percentage by your plan, resulting in lower out-of-pocket expenses for you (e.g., lower copayments, deductibles, and coinsurance). Out-of-network costs, on the other hand, are for services from providers who do not have a contract with your insurer. Your plan might cover a smaller portion, or sometimes none at all, leading to significantly higher out-of-pocket costs. To get a better understanding of what your specific insurance might pay, using a tool like Payerprice with CPT codes can help reveal fee schedules that contribute to these cost differences.
Payerprice assists users by providing a fee schedule lookup tool that allows you to search for healthcare service prices using CPT codes and your specific location. This tool offers transparency into what various payers reimburse for different procedures, helping you compare costs, understand potential out-of-pocket expenses, and negotiate prices if necessary. It provides more granular, specific pricing data compared to general information, empowering you to make more informed healthcare decisions.