How much does Medicare pay for CPT 87040?

Medicare allowed an average of $10.09 per service and paid $10.09 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $87.87, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 87040?

Bacterial blood culture. It was billed 52,560 times to 30,918 Medicare beneficiaries by 182 providers in 2024.

Does 87040 pay differently in an office than a hospital?

Yes. The allowed amount averaged $10.09 in an office setting and $10.11 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 87040 most?

Clinical Laboratory, with 52,116 services from 174 clinicians. Next are Pathology, Hematology-Oncology, Family Practice.

CPT 87040

Bacterial blood culture

$10.09Medicare-allowed amount per service, averaged across 52,560 services

Providers submitted

$87.87

Asking price, not received

Medicare allowed

$10.09

The fee schedule figure

Medicare paid

$10.09

Balance is patient coinsurance

Providers submitted an average of $87.87 for this code and Medicare allowed $10.09 — 8.7× 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 $10.09 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $10.09
Hospital / facility: $10.11

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 52,456 services were billed in an office setting and 104 in a facility.

Services: 52,560
Beneficiaries: 30,918
Providers billing it: 182
Total allowed: $530,330

What Medicare pays for CPT 87040

Across 52,560 services billed by 182 providers to 30,918 beneficiaries, Medicare allowed an average of $10.09 per service. That is 1.7 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 87040

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	52,116	30,654	$10.09	174
Pathology	294	176	$10.11	4
Hematology-Oncology	88	48	$10.11	1
Family Practice	38	29	$10.11	2
Nurse Practitioner	24	11	$10.12	1

87040 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
California	10,730	$10.09	$10.11	34
New Jersey	9,745	$10.09	$10.09	9
Florida	4,719	$10.09	$10.10	12
Texas	3,975	$10.09	$10.10	14
New York	2,910	$10.11	$10.11	6
North Carolina	2,256	$10.11	$10.13	3
Illinois	1,682	$10.11	$10.11	6
Arizona	1,589	$10.10	$10.11	4
Massachusetts	1,483	$10.11	$10.11	6
Kansas	1,157	$10.11	$10.11	5
Ohio	1,122	$10.05	$10.07	5
Minnesota	1,114	$10.08	$10.11	4
Alabama	1,053	$10.09	$10.11	3
Washington	869	$10.05	$10.11	4
Pennsylvania	824	$10.08	$10.11	6
Georgia	823	$10.04	$10.09	3
Virginia	786	$10.06	$10.11	5
Tennessee	766	$10.10	$10.11	5
Nevada	734	$10.02	$10.11	4
Maryland	671	$10.07	$10.09	5
Wisconsin	484	$9.91	$10.11	4
Oklahoma	481	$10.06	$10.09	4
Colorado	394	$9.98	$9.98	2
Hawaii	361	$10.11	$10.11	2
Iowa	283	$10.11	$10.11	4
Oregon	263	$10.08	$10.11	4
Louisiana	201	$10.11	$10.11	2
Missouri	169	$10.06	$10.06	2
Utah	136	$10.11	$10.11	1
Maine	121	$10.11	$10.11	1
New Mexico	110	$10.11	$10.11	1
Nebraska	101	$10.03	$10.11	2
North Dakota	87	$10.11	$10.11	1
Rhode Island	87	$10.11	$10.11	1
Indiana	69	$9.98	$10.11	1
South Dakota	61	$10.11	$10.11	1
Kentucky	47	$10.11	$10.11	2
Michigan	41	$10.11	$10.11	2
South Carolina	34	$10.11	$10.11	1
Connecticut	22	$9.77	$10.11	1

Related codes

87086Bacterial colony count$7.90
87088Bacterial urine culture$7.92
87077Bacterial culture for aerobic isolates$7.91
87070Bacterial culture$8.44
87075Bacterial culture$9.27
87045Stool culture$9.24
87046Stool culture$9.24
87081Screening test for pathogenic organisms$6.49
87015Concentration of specimen for infectious agents$6.54
87076Bacterial culture for anaerobic isolates$7.91
87084Screening test for pathogenic organisms$26.42
87071Bacterial culture and colony count$9.67

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.