How much does Medicare pay for CPT 87220?

Medicare allowed an average of $4.17 per service and paid $4.17 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $43.51, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 87220?

Tissue fungi or parasites. It was billed 12,413 times to 11,373 Medicare beneficiaries by 226 providers in 2024.

Does 87220 pay differently in an office than a hospital?

Yes. The allowed amount averaged $4.17 in an office setting and $4.18 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 87220 most?

Clinical Laboratory, with 7,914 services from 47 clinicians. Next are Dermatology, Physician Assistant, Pathology.

CPT 87220

Tissue fungi or parasites

$4.17Medicare-allowed amount per service, averaged across 12,413 services

Providers submitted

$43.51

Asking price, not received

Medicare allowed

$4.17

The fee schedule figure

Medicare paid

$4.17

Balance is patient coinsurance

Providers submitted an average of $43.51 for this code and Medicare allowed $4.17 — 10.4× 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 $4.17 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $4.17
Hospital / facility: $4.18

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 12,356 services were billed in an office setting and 57 in a facility.

Services: 12,413
Beneficiaries: 11,373
Providers billing it: 226
Total allowed: $51,762

What Medicare pays for CPT 87220

Across 12,413 services billed by 226 providers to 11,373 beneficiaries, Medicare allowed an average of $4.17 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 87220

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	7,914	7,519	$4.18	47
Dermatology	2,501	2,121	$4.16	96
Physician Assistant	614	566	$4.15	38
Pathology	516	432	$4.17	6
Obstetrics & Gynecology	341	257	$4.17	6
Nurse Practitioner	247	226	$4.18	16
Family Practice	166	144	$4.15	10
Micrographic Dermatologic Surgery	86	82	$4.13	5
Podiatry	15	13	$4.18	1
Internal Medicine	13	13	$4.18	1

87220 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	1,829	$4.18	$4.18	28
Florida	1,681	$4.18	$4.18	14
New Jersey	1,462	$4.18	$4.18	2
Massachusetts	771	$4.18	$4.18	12
Georgia	613	$4.17	$4.18	11
New York	568	$4.18	$4.18	6
Texas	544	$4.17	$4.18	7
North Carolina	496	$4.17	$4.18	10
Illinois	483	$4.18	$4.18	6
Mississippi	457	$4.15	$4.18	2
Missouri	409	$4.18	$4.18	5
Pennsylvania	374	$4.18	$4.18	11
Nevada	334	$4.18	$4.18	3
Kansas	325	$4.16	$4.18	16
Maryland	325	$4.16	$4.18	8
South Carolina	209	$4.17	$4.18	9
Virginia	206	$4.16	$4.18	12
Washington	178	$4.14	$4.18	9
Wisconsin	167	$4.18	$4.18	8
Arkansas	160	$4.15	$4.18	8
Ohio	118	$4.18	$4.18	4
Oklahoma	106	$4.18	$4.18	2
Tennessee	92	$4.10	$4.18	5
Colorado	61	$4.18	$4.18	4
Montana	60	$4.18	$4.18	3
Iowa	58	$4.18	$4.18	3
Arizona	56	$4.18	$4.18	3
Oregon	55	$4.12	$4.18	3
Utah	45	$4.18	$4.18	2
Nebraska	40	$4.08	$4.18	2
Indiana	32	$4.18	$4.18	2
North Dakota	27	$4.18	$4.18	1
Minnesota	26	$4.18	$4.18	2
West Virginia	22	$4.18	$4.18	1
Alabama	12	$4.18	$4.18	1
Connecticut	12	$4.18	$4.18	1

Related codes

87205Special gram or giemsa stain for microorganism$4.17
87209Special stain for parasites$17.57
87206Special fluorescent and/or acid fast stain for microorganism$5.27
87210Smear for infectious agents$5.67
87207Special stain for inclusion bodies or parasites$7.96
87255Virus isolation$33.06
87230Microbial toxin or antitoxin assay$19.34
87254Virus isolation$18.86
87275Detection test by immunofluorescent technique for influenza b virus$11.88
87276Detection test by immunofluorescent technique for influenza a virus$15.50
87252Tissue culture inoculation for virus isolation$25.53

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.