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See a sample rate comparisonCPT 87880 Fee Schedule
Medicare rates as of January 2026
CPT 87880 is classified under Pathology and Laboratory Procedures, in the Microbiology Procedures subgroup.
Infectious Agent Detection By, Infectious Agent Detection By Immunoassay With Directoptical Observation Streptococcus Group A Infectious Agent Detection By Immunoassay With Direct
| Key Fact | Detail |
|---|---|
| Service Type | Pathology and Laboratory Procedures Microbiology Procedures |
| Common Place of Service | 11 - Office 20 - Urgent Care Facility |
| Common Modifiers | QW - CLIA Waived Tests 26 - Professional component |
| Complexity Level | Low |
| Medicare Fee Schedule | $16.53 national lab fee schedule rate (2026) · View Medicare rates for 87880 |
| Medicaid Fee Schedule | $15.21 median of the 8 states in the free preview · View Medicaid rates for 87880 |
National average reimbursement for CPT 87880 by major payers:
$14.40
BCBS / Anthem
$13.20
UnitedHealthcare
$17.41
Aetna
$22.67
Cigna
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CPT 87880
5 of 25 sample ratesHigher to lower in this preview
Swati Gupta
Avenel Iselin Medical Group
$16.53Published rateRajiv Patel
Princeton Healthcare Affiliated Physicians PC
$16.07Published rateAlla Roitman
Radu Codel, Md, PC
$15.69Published rateSamuel Preschel
Lakewood Immediate Care
$8.34Published rateAnjana Chhabra
Mdslim LLC
$7.23Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 87880 vs. Other Microbiology Procedures Codes
The table lists codes related to 87880. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 87802-CPT | Low | Infectious Agent Antigen Detec, Infectious Agent Antigen Detection By Immunoassay With Direct Optical (Ie Visual) Observation Streptococcus Group B |
| 87803-CPT | Low | Test For Intestinal Infection, The Test Detects Toxins Produced By Clostridium Difficile Bacteria Which Causes Diarrhea And Usually Results From Antibiotic Use. |
| 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. |
| 87880-CPT | Low | Infectious Agent Detection By, Infectious Agent Detection By Immunoassay With Directoptical Observation Streptococcus Group A Infectious Agent Detection By Immunoassay With Direct |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 87880. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 87880 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
The cost of medical procedures can vary significantly based on location, provider, and your specific insurance plan. To get an estimate for a specific procedure using a CPT code and your location, you can utilize tools like Payerprice. They offer a fee schedule lookup tool that allows you to search for pricing information.
CPT stands for "Current Procedural Terminology." CPT codes are five-digit codes used by healthcare providers to describe medical, surgical, and diagnostic services. They are crucial for billing and reimbursement purposes, as they standardize the reporting of services and procedures. Knowing the CPT code for a service helps you understand what you're being billed for and can assist in researching pricing.
Medical costs can vary due to several factors, including the geographic location, the specific healthcare provider or facility (e.g., hospital vs. independent clinic), your insurance plan's negotiated rates, the complexity of your individual case, and whether the service is in-network or out-of-network. Different providers may also have different overhead costs and pricing strategies.
Comparing prices can be challenging due to the variability in healthcare costs. However, you can start by asking your provider for the CPT code for the service you need. With the CPT code and your specific location, you can use tools like Payerprice's fee schedule lookup tool to search for and compare potential costs across different providers. It's also advisable to contact your insurance company for estimates based on your specific plan benefits.
First, carefully review the bill for any errors and compare it to your Explanation of Benefits (EOB) from your insurance company. If you find discrepancies or have questions, contact your healthcare provider's billing department to request an itemized bill and clarify charges. You can also contact your insurance company for clarification on coverage. If necessary, you may be able to negotiate the bill or set up a payment plan.
Generally, no. Most health insurance plans require you to pay a portion of your medical costs, even after meeting your deductible. This can include deductibles (the amount you pay before your insurance starts to cover costs), co-pays (a fixed amount you pay for a service), and co-insurance (a percentage of the cost you pay). Most plans also have an out-of-pocket maximum, which is the most you'll have to pay in a policy year for covered services. It's essential to understand your specific plan's benefits.