How much does Medicare pay for CPT 87481?

Medicare allowed an average of $34.05 per service and paid $34.05 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $60.12, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 87481?

Detection test for candida species (yeast), amplified probe technique. It was billed 2,935,874 times to 674,378 Medicare beneficiaries by 1,217 providers in 2024.

Does 87481 pay differently in an office than a hospital?

Yes. The allowed amount averaged $34.05 in an office setting and $34.39 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 87481 most?

Clinical Laboratory, with 2,575,696 services from 489 clinicians. Next are Urology, Pathology, Podiatry.

CPT 87481

Detection test for candida species (yeast), amplified probe technique

$34.05Medicare-allowed amount per service, averaged across 2,935,874 services

Providers submitted

$60.12

Asking price, not received

Medicare allowed

$34.05

The fee schedule figure

Medicare paid

$34.05

Balance is patient coinsurance

Providers submitted an average of $60.12 for this code and Medicare allowed $34.05 — 1.8× 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 $34.05 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $34.05
Hospital / facility: $34.39

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 2,935,689 services were billed in an office setting and 185 in a facility.

Services: 2,935,874
Beneficiaries: 674,378
Providers billing it: 1,217
Total allowed: $99,966,510

What Medicare pays for CPT 87481

Across 2,935,874 services billed by 1,217 providers to 674,378 beneficiaries, Medicare allowed an average of $34.05 per service. That is 4.4 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 87481

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	2,575,696	577,133	$34.02	489
Urology	140,549	33,743	$34.26	328
Pathology	126,758	39,716	$34.30	64
Podiatry	37,001	8,551	$34.33	83
Nurse Practitioner	23,156	6,469	$34.26	93
Physician Assistant	14,057	3,478	$34.37	54
Internal Medicine	6,405	1,920	$34.37	14
Obstetrics & Gynecology	5,431	1,685	$34.34	60
Family Practice	4,879	1,133	$34.34	20
Hematology-Oncology	883	178	$34.27	1
Dermatology	273	60	$34.39	2
Emergency Medicine	237	67	$34.39	3
General Practice	234	59	$34.26	2
Interventional Pain Management	148	98	$34.39	1
Gastroenterology	106	50	$33.74	1

87481 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
Texas	934,470	$34.37	$34.39	302
Pennsylvania	337,983	$34.38	$34.39	19
California	324,815	$34.29	$34.39	106
Florida	244,651	$34.27	$34.39	100
New Jersey	131,642	$34.31	$34.39	50
Arkansas	104,858	$34.33	$34.39	10
Maryland	101,143	$34.37	$34.39	56
Arizona	100,632	$33.87	$34.39	11
Mississippi	88,084	$34.35	$34.39	48
Illinois	87,004	$34.34	$34.39	44
New York	86,311	$34.33	$34.39	64
Colorado	70,433	$34.37	$34.39	49
Oklahoma	65,266	$34.36	$34.39	42
Louisiana	54,671	$34.38	$34.39	31
Indiana	47,095	$17.69	$34.39	10
Virginia	38,194	$34.36	$34.39	21
Michigan	12,528	$34.08	$34.39	15
Massachusetts	10,188	$34.35	$34.39	31
Tennessee	10,028	$34.35	$34.39	17
Utah	9,727	$34.38	$34.39	5
North Carolina	9,116	$34.38	$34.39	4
Kansas	8,947	$34.36	$34.39	8
Missouri	7,465	$32.51	$34.39	10
Ohio	6,647	$34.37	$34.39	9
Delaware	6,534	$34.35	$34.39	25
Connecticut	4,692	$34.30	$34.39	9
Nevada	4,590	$34.05	$34.39	7
Nebraska	3,406	$34.30	$34.39	12
Georgia	3,172	$34.37	$34.39	9
Wisconsin	3,167	$33.46	$34.39	2
New Hampshire	2,587	$34.39	$34.39	15
Puerto Rico	2,284	$34.34	$34.39	3
New Mexico	2,077	$34.20	$34.39	9
Washington	1,969	$34.29	$34.39	11
Minnesota	1,882	$34.24	$34.39	12
Oregon	1,841	$33.84	$34.39	6
Alabama	1,503	$33.67	$34.39	8
Iowa	1,461	$34.39	$34.39	7
Kentucky	946	$34.25	$34.39	3
Wyoming	696	$28.73	$34.39	8
District of Columbia	385	$34.39	$34.39	1
South Carolina	324	$34.39	$34.39	1
Idaho	129	$34.39	$34.39	2
West Virginia	88	$34.39	$34.39	1
Maine	86	$34.39	$34.39	1
Rhode Island	79	$34.39	$34.39	1
Hawaii	44	$34.39	$34.39	1
Alaska	34	$33.06	$34.39	1

Related codes

87426Detection test by immunoassay technique for severe acute respiratory s$34.33
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

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.