CPT 87426

Across 510,998 services billed by 13,735 providers to 460,653 beneficiaries, Medicare allowed an average of $34.33 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.

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.

• 87481Detection test for candida species (yeast)$34.05
• 87428Detection test by immunoassay technique for severe acute respiratory s$67.08
• 87486Detection test by nucleic acid for chlamydia pneumoniae$34.36
• 87491Detection test by nucleic acid for chlamydia trachomatis$34.35
• 87449Detection test by immunoassay technique for other organism$11.73
• 87498Detection test by nucleic acid for enterovirus (intestinal virus)$34.38
• 87497Detection test by nucleic acid for cytomegalovirus$41.82
• 87493Detection test by nucleic acid for clostridium difficile$36.38
• 87427Detection test by immunoassay technique for shiga-like toxin (bacteria$11.69
• 87496Detection test by nucleic acid for cytomegalovirus (cmv)$34.38
• 87400Detection test by immunoassay technique for influenza virus$13.75
• 87480Detection test for candida species (yeast)$19.59

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.

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