How much does Medicare pay for CPT 87109?

Medicare allowed an average of $15.07 per service and paid $15.07 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $115.37, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 87109?

Mycoplasma culture. It was billed 3,027 times to 2,633 Medicare beneficiaries by 33 providers in 2024.

Which specialty bills 87109 most?

Clinical Laboratory, with 2,895 services from 30 clinicians. Next are Obstetrics & Gynecology, Family Practice, Urology.

CPT 87109

Mycoplasma culture

$15.07Medicare-allowed amount per service, averaged across 3,027 services

Providers submitted

$115.37

Asking price, not received

Medicare allowed

$15.07

The fee schedule figure

Medicare paid

$15.07

Balance is patient coinsurance

Providers submitted an average of $115.37 for this code and Medicare allowed $15.07 — 7.7× 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 $15.07 (100%); the rest is the patient’s coinsurance and deductible.

Services: 3,027
Beneficiaries: 2,633
Providers billing it: 33
Total allowed: $45,617

What Medicare pays for CPT 87109

Across 3,027 services billed by 33 providers to 2,633 beneficiaries, Medicare allowed an average of $15.07 per service. 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 87109

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	2,895	2,527	$15.07	30
Obstetrics & Gynecology	100	79	$15.08	1
Family Practice	17	12	$15.08	1
Urology	15	15	$15.08	1

87109 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	609	$15.08	$15.08	5
North Carolina	585	$15.08	$15.08	1
Virginia	512	$15.43	$15.08	1
California	239	$14.23	$15.08	7
Arkansas	229	$15.08	$15.08	1
Alabama	210	$15.08	$15.08	2
New York	173	$15.08	$15.08	3
Oregon	129	$14.93	$15.08	1
Texas	59	$15.08	$15.08	1
Nevada	52	$15.08	$15.08	1
Arizona	50	$15.08	$15.08	2
Maryland	38	$15.08	$15.08	1
Utah	35	$15.08	$15.08	1
Indiana	26	$15.08	$15.08	1
Ohio	18	$15.08	$15.08	1
Illinois	17	$15.08	$15.08	1
Florida	16	$15.08	$15.08	1
Tennessee	15	$15.08	$15.08	1
Oklahoma	15	$15.08	$15.08	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
87101Fungal culture (mold or yeast) of skin$7.56
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

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.