How much does Medicare pay for CPT 87086?

Medicare allowed an average of $7.90 per service and paid $7.90 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $51.17, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 87086?

Bacterial colony count, urine. It was billed 4,406,190 times to 2,948,635 Medicare beneficiaries by 4,506 providers in 2024.

Does 87086 pay differently in an office than a hospital?

Yes. The allowed amount averaged $7.90 in an office setting and $7.90 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 87086 most?

Clinical Laboratory, with 4,052,466 services from 558 clinicians. Next are Pathology, Urology, Family Practice.

CPT 87086

Bacterial colony count, urine

$7.90Medicare-allowed amount per service, averaged across 4,406,190 services

Providers submitted

$51.17

Asking price, not received

Medicare allowed

$7.90

The fee schedule figure

Medicare paid

$7.90

Balance is patient coinsurance

Providers submitted an average of $51.17 for this code and Medicare allowed $7.90 — 6.5× 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 $7.90 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $7.90
Hospital / facility: $7.90

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 4,404,792 services were billed in an office setting and 1,398 in a facility.

Services: 4,406,190
Beneficiaries: 2,948,635
Providers billing it: 4,506
Total allowed: $34,808,901

What Medicare pays for CPT 87086

Across 4,406,190 services billed by 4,506 providers to 2,948,635 beneficiaries, Medicare allowed an average of $7.90 per service. That is 1.5 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 87086

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	4,052,466	2,692,658	$7.90	558
Pathology	124,279	85,071	$7.88	37
Urology	96,239	64,090	$7.89	599
Family Practice	40,994	32,257	$7.87	980
Internal Medicine	29,816	23,113	$7.89	717
Nurse Practitioner	27,798	22,966	$7.88	790
Physician Assistant	20,887	17,811	$7.87	547
Obstetrics & Gynecology	5,540	3,998	$7.87	95
Emergency Medicine	2,559	2,352	$7.86	94
Hematology-Oncology	1,833	1,404	$7.89	9
Pediatric Medicine	1,270	903	$7.87	10
Nephrology	826	658	$7.88	24
General Practice	422	344	$7.79	7
Cardiology	273	227	$7.88	5
Geriatric Medicine	214	155	$7.91	6

87086 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
New Jersey	526,030	$7.90	$7.91	278
Florida	493,914	$7.91	$7.91	86
California	480,011	$7.90	$7.91	120
Texas	427,742	$7.90	$7.91	414
North Carolina	307,521	$7.91	$7.91	228
New York	224,886	$7.90	$7.91	639
Arizona	177,744	$7.90	$7.91	151
Ohio	169,513	$7.90	$7.91	56
Illinois	151,060	$7.90	$7.91	60
Tennessee	133,871	$7.89	$7.91	68
Alabama	129,535	$7.90	$7.91	72
Massachusetts	122,471	$7.91	$7.91	361
Georgia	112,485	$7.90	$7.91	68
Virginia	101,114	$7.90	$7.91	273
Kansas	96,493	$7.91	$7.91	13
Pennsylvania	87,811	$7.90	$7.91	25
Washington	74,372	$7.90	$7.91	196
Maryland	64,220	$7.90	$7.91	34
Oklahoma	51,497	$7.90	$7.91	17
Colorado	44,279	$7.90	$7.91	20
South Carolina	43,714	$7.91	$7.91	20
Wisconsin	42,946	$7.82	$7.91	38
Louisiana	37,783	$7.90	$7.91	78
Nevada	32,581	$7.90	$7.91	7
Oregon	31,835	$7.87	$7.91	78
Missouri	24,899	$7.91	$7.91	28
Minnesota	24,536	$7.88	$7.91	392
Kentucky	23,881	$7.88	$7.91	98
Michigan	21,749	$7.89	$7.91	44
Iowa	19,400	$7.90	$7.91	102
Indiana	18,763	$7.89	$7.91	15
Hawaii	17,966	$7.90	$7.91	2
Utah	12,654	$7.90	$7.91	73
Arkansas	10,939	$7.89	$7.91	32
Nebraska	10,770	$7.90	$7.91	6
Rhode Island	8,972	$7.90	$7.91	2
South Dakota	8,938	$7.90	$7.91	32
New Mexico	7,708	$7.89	$7.91	8
Idaho	5,544	$7.89	$7.91	44
Mississippi	4,949	$7.89	$7.91	10
Connecticut	3,854	$7.85	$7.91	8
Puerto Rico	3,648	$7.88	$7.91	72
Maine	3,375	$7.90	$7.91	38
North Dakota	2,729	$7.86	$7.91	16
New Hampshire	1,980	$7.89	$7.91	52
Delaware	1,745	$7.91	$7.91	3
West Virginia	840	$7.89	$7.91	7
District of Columbia	353	$7.89	$7.91	2
Wyoming	215	$7.88	$7.91	7
U.S. Virgin Islands	140	$7.91	$7.91	1
Alaska	90	$7.91	$7.91	5
Montana	81	$7.85	$7.91	4
Vermont	44	$7.91	$7.91	3

Related codes

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
87040Bacterial blood culture$10.09
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.