How much does Medicare pay for CPT 87116?

Medicare allowed an average of $10.56 per service and paid $10.56 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $89.45, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 87116?

Culture for acid-fast bacilli. It was billed 33,496 times to 19,974 Medicare beneficiaries by 102 providers in 2024.

Which specialty bills 87116 most?

Clinical Laboratory, with 33,281 services from 99 clinicians. Next are Pathology, Hematology-Oncology.

CPT 87116

Culture for acid-fast bacilli

$10.56Medicare-allowed amount per service, averaged across 33,496 services

Providers submitted

$89.45

Asking price, not received

Medicare allowed

$10.56

The fee schedule figure

Medicare paid

$10.56

Balance is patient coinsurance

Providers submitted an average of $89.45 for this code and Medicare allowed $10.56 — 8.5× 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 $10.56 (100%); the rest is the patient’s coinsurance and deductible.

Services: 33,496
Beneficiaries: 19,974
Providers billing it: 102
Total allowed: $353,718

What Medicare pays for CPT 87116

Across 33,496 services billed by 102 providers to 19,974 beneficiaries, Medicare allowed an average of $10.56 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 87116

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	33,281	19,855	$10.56	99
Pathology	157	90	$10.58	2
Hematology-Oncology	58	29	$10.58	1

87116 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	6,070	$10.57	$10.58	22
Florida	4,415	$10.57	$10.58	8
New Jersey	3,655	$10.57	$10.58	4
North Carolina	3,425	$10.58	$10.58	1
Texas	3,292	$10.57	$10.58	9
New York	1,345	$10.57	$10.58	3
Hawaii	1,230	$10.56	$10.58	2
Alabama	1,087	$10.58	$10.58	1
Arizona	1,050	$10.57	$10.58	2
Minnesota	966	$10.50	$10.58	4
Kansas	744	$10.58	$10.58	4
Tennessee	681	$10.58	$10.58	3
Virginia	681	$10.48	$10.58	3
Nevada	666	$10.54	$10.58	1
Wisconsin	659	$10.29	$10.58	2
Ohio	499	$10.54	$10.58	5
Georgia	457	$10.58	$10.58	1
Massachusetts	395	$10.58	$10.58	2
Washington	361	$10.58	$10.58	1
Illinois	271	$10.58	$10.58	1
Oklahoma	237	$10.58	$10.58	3
Pennsylvania	235	$10.58	$10.58	4
New Mexico	205	$10.55	$10.58	1
Maryland	174	$10.58	$10.58	1
Maine	157	$10.58	$10.58	1
Utah	146	$10.58	$10.58	2
Oregon	100	$10.58	$10.58	2
Iowa	69	$10.58	$10.58	1
South Dakota	54	$10.58	$10.58	2
Indiana	37	$10.58	$10.58	1
Nebraska	35	$10.58	$10.58	1
Rhode Island	30	$10.58	$10.58	1
Kentucky	30	$10.58	$10.58	1
Mississippi	19	$10.58	$10.58	1
Colorado	19	$10.58	$10.58	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
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.