How much does Medicare pay for CPT 81007?

Medicare allowed an average of $29.27 per service and paid $29.27 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $53.14, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 81007?

Urinalysis for bacteria. It was billed 157,431 times to 56,086 Medicare beneficiaries by 250 providers in 2024.

Does 81007 pay differently in an office than a hospital?

Yes. The allowed amount averaged $29.27 in an office setting and $29.38 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 81007 most?

Nurse Practitioner, with 42,089 services from 30 clinicians. Next are Urology, Clinical Laboratory, Nephrology.

CPT 81007

Urinalysis for bacteria

$29.27Medicare-allowed amount per service, averaged across 157,431 services

Providers submitted

$53.14

Asking price, not received

Medicare allowed

$29.27

The fee schedule figure

Medicare paid

$29.27

Balance is patient coinsurance

Providers submitted an average of $53.14 for this code and Medicare allowed $29.27 — 1.8× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $29.27 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $29.27
Hospital / facility: $29.38

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 157,344 services were billed in an office setting and 87 in a facility.

Services: 157,431
Beneficiaries: 56,086
Providers billing it: 250
Total allowed: $4,608,005

What Medicare pays for CPT 81007

Across 157,431 services billed by 250 providers to 56,086 beneficiaries, Medicare allowed an average of $29.27 per service. That is 2.8 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 81007

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	42,089	3,887	$29.27	30
Urology	36,363	24,034	$29.23	95
Clinical Laboratory	30,327	19,095	$29.30	18
Nephrology	22,378	964	$29.36	8
Internal Medicine	16,252	1,269	$29.26	24
Physician Assistant	5,217	4,336	$29.18	42
Obstetrics & Gynecology	1,985	894	$29.18	6
Family Practice	817	412	$28.52	12
Pathology	549	440	$29.38	2
General Practice	474	207	$29.38	1
Rheumatology	375	162	$28.64	2
Endocrinology	221	153	$29.38	1
Physical Medicine and Rehabilitation	120	41	$29.38	2
Hematology-Oncology	102	49	$29.38	1
Cardiac Surgery	59	45	$29.38	1

81007 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Arizona	76,421	$29.38	$29.38	12
Florida	12,713	$29.18	$29.23	24
Louisiana	11,969	$29.37	$29.38	8
Georgia	10,608	$29.03	$29.38	46
Alabama	5,819	$29.14	$29.37	8
Missouri	5,809	$29.38	$29.38	8
Oklahoma	5,114	$29.10	$29.38	10
Massachusetts	4,324	$29.37	$29.38	11
Arkansas	3,771	$29.20	$29.38	4
Delaware	3,385	$29.20	$29.38	7
North Carolina	3,187	$29.28	$29.38	7
Illinois	2,502	$29.37	$29.38	5
Mississippi	2,036	$26.90	$29.38	10
Maine	1,948	$29.24	$29.38	5
Alaska	1,602	$29.12	$29.38	11
Tennessee	1,500	$29.29	$29.38	14
Texas	1,110	$29.29	$29.38	10
California	957	$29.38	$29.38	7
New Jersey	600	$29.38	$29.38	9
West Virginia	530	$28.63	$29.34	1
Ohio	482	$29.32	$29.38	12
Virginia	276	$29.29	$29.38	2
Indiana	209	$29.38	$29.38	9
New Hampshire	194	$29.38	$29.38	1
Nevada	149	$29.38	$29.38	2
Pennsylvania	68	$29.38	$29.38	2
South Carolina	60	$29.12	$29.38	2
Washington	41	$23.38	$29.38	1
Michigan	32	$29.38	$29.38	1
New Mexico	15	$27.66	$29.38	1

Related codes

81001Manual urinalysis test$3.10
81003Automated urinalysis test$2.19
81002Urinalysis, manual test$3.39
81000Manual urinalysis test$3.92
81015Urinalysis using microscope$2.98
81050Urine volume measurement$3.57
81005Analysis of urine$2.13
81025Urine pregnancy test$8.33

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.