How much does Medicare pay for CPT 87101?

Medicare allowed an average of $7.56 per service and paid $7.56 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $62.82, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 87101?

Fungal culture (mold or yeast) of skin, hair, or nail. It was billed 62,105 times to 44,424 Medicare beneficiaries by 163 providers in 2024.

Does 87101 pay differently in an office than a hospital?

Yes. The allowed amount averaged $7.56 in an office setting and $7.56 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 87101 most?

Clinical Laboratory, with 55,603 services from 100 clinicians. Next are Pathology, Podiatry, Dermatology.

CPT 87101

Fungal culture (mold or yeast) of skin, hair, or nail

$7.56Medicare-allowed amount per service, averaged across 62,105 services

Providers submitted

$62.82

Asking price, not received

Medicare allowed

$7.56

The fee schedule figure

Medicare paid

$7.56

Balance is patient coinsurance

Providers submitted an average of $62.82 for this code and Medicare allowed $7.56 — 8.3× 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 $7.56 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $7.56
Hospital / facility: $7.56

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 62,045 services were billed in an office setting and 60 in a facility.

Services: 62,105
Beneficiaries: 44,424
Providers billing it: 163
Total allowed: $469,514

What Medicare pays for CPT 87101

Across 62,105 services billed by 163 providers to 44,424 beneficiaries, Medicare allowed an average of $7.56 per service. That is 1.4 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 87101

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	55,603	38,912	$7.56	100
Pathology	2,905	2,777	$7.56	6
Podiatry	2,216	1,578	$7.55	10
Dermatology	841	752	$7.49	32
Nurse Practitioner	278	212	$7.51	5
Physician Assistant	111	98	$7.46	6
Infectious Disease	87	36	$7.56	1
Hematology-Oncology	29	27	$7.56	1
Internal Medicine	22	21	$7.56	1
Family Practice	13	11	$7.56	1

87101 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
Florida	23,584	$7.56	$7.56	18
New Jersey	8,770	$7.56	$7.56	5
North Carolina	6,874	$7.56	$7.56	1
California	6,253	$7.56	$7.56	24
Georgia	3,411	$7.56	$7.56	9
Texas	3,296	$7.55	$7.56	9
Alabama	2,005	$7.55	$7.56	2
Illinois	905	$7.54	$7.56	5
Ohio	868	$7.55	$7.56	4
Washington	744	$7.56	$7.56	6
Massachusetts	690	$7.56	$7.56	4
Missouri	546	$7.56	$7.56	1
Arizona	529	$7.54	$7.56	4
Maryland	401	$7.56	$7.56	2
New York	368	$7.56	$7.56	6
Colorado	314	$7.49	$7.56	2
Tennessee	309	$7.56	$7.56	4
Pennsylvania	300	$7.56	$7.56	4
Oregon	259	$7.54	$7.56	6
Oklahoma	240	$7.56	$7.56	2
Wisconsin	174	$7.47	$7.56	4
Nevada	173	$7.56	$7.56	3
Wyoming	165	$7.44	$7.56	5
Kansas	158	$7.56	$7.56	6
Hawaii	142	$7.56	$7.56	2
Michigan	113	$7.56	$7.56	2
Nebraska	97	$7.56	$7.56	3
Minnesota	96	$7.41	$7.56	4
Louisiana	64	$7.56	$7.56	3
Alaska	36	$7.56	$7.56	1
Maine	34	$7.56	$7.56	1
Virginia	32	$7.56	$7.56	2
Connecticut	23	$7.26	$7.56	1
New Mexico	23	$7.56	$7.56	1
Rhode Island	21	$7.56	$7.56	1
Indiana	20	$7.56	$7.56	1
South Carolina	19	$7.24	$7.56	1
North Dakota	14	$7.56	$7.56	1
Utah	13	$7.56	$7.56	1
Iowa	11	$7.56	$7.56	1
South Dakota	11	$7.56	$7.56	1

Related codes

87186Evaluation of antimicrobial drug (antibiotic$8.47
87150Identification of organisms by genetic analysis$34.30
87177Smear for parasites$8.69
87184Evaluation of antimicrobial drug (antibiotic$7.32
87147Identification of organisms by immunologic analysis$5.08
87102Fungal culture (mold or yeast)$8.23
87116Culture for acid-fast bacilli$10.56
87106Fungal culture$10.10
87181Evaluation of antimicrobial drug (antibiotic$4.63
87107Culture for identification of yeast$10.11
87185Detection of antimicrobial drug (antibiotic$4.65
87118Identification of mycobacteria (tb or tb like organism)$14.31

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.