How much does Medicare pay for CPT 87491?

Medicare allowed an average of $34.35 per service and paid $34.35 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $86.43, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 87491?

Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique. It was billed 253,604 times to 197,697 Medicare beneficiaries by 587 providers in 2024.

Does 87491 pay differently in an office than a hospital?

Yes. The allowed amount averaged $34.35 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 87491 most?

Clinical Laboratory, with 237,605 services from 402 clinicians. Next are Urology, Pathology, Obstetrics & Gynecology.

CPT 87491

Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique

$34.35Medicare-allowed amount per service, averaged across 253,604 services

Providers submitted

$86.43

Asking price, not received

Medicare allowed

$34.35

The fee schedule figure

Medicare paid

$34.35

Balance is patient coinsurance

Providers submitted an average of $86.43 for this code and Medicare allowed $34.35 — 2.5× 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 $34.35 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $34.35
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. 253,566 services were billed in an office setting and 38 in a facility.

Services: 253,604
Beneficiaries: 197,697
Providers billing it: 587
Total allowed: $8,711,297

What Medicare pays for CPT 87491

Across 253,604 services billed by 587 providers to 197,697 beneficiaries, Medicare allowed an average of $34.35 per service. That is 1.3 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 87491

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	237,605	185,365	$34.35	402
Urology	5,698	3,806	$34.31	39
Pathology	4,610	4,243	$34.25	48
Obstetrics & Gynecology	2,410	2,164	$34.31	46
Physician Assistant	906	764	$34.33	13
Nurse Practitioner	610	439	$34.14	9
Family Practice	589	337	$34.39	10
Internal Medicine	573	261	$34.33	8
Infectious Disease	465	202	$34.39	5
Hematology-Oncology	58	57	$34.39	4
Gastroenterology	38	22	$34.39	1
General Practice	23	18	$34.39	1
Hematology	19	19	$32.83	1

87491 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	66,905	$34.37	$34.39	77
California	41,159	$34.36	$34.39	91
New Jersey	30,500	$34.36	$34.39	20
Florida	20,885	$34.29	$34.39	39
Arizona	11,437	$34.36	$34.39	8
Illinois	9,298	$34.38	$34.39	25
Oklahoma	8,238	$34.32	$34.39	20
New York	8,074	$34.36	$34.39	51
Pennsylvania	7,907	$34.38	$34.39	19
North Carolina	7,728	$34.35	$34.39	7
Massachusetts	5,463	$34.39	$34.39	12
Colorado	3,327	$34.39	$34.39	12
Utah	3,317	$34.39	$34.39	3
Michigan	2,760	$34.28	$34.39	15
Alabama	2,600	$34.24	$34.39	7
Missouri	2,483	$34.36	$34.38	7
Maryland	2,202	$34.36	$34.39	10
Kansas	1,886	$34.36	$34.39	8
West Virginia	1,685	$34.37	$34.39	2
Tennessee	1,664	$34.39	$34.39	18
Ohio	1,264	$34.39	$34.39	7
Georgia	1,233	$34.38	$34.39	4
Nevada	1,206	$34.07	$34.39	7
Washington	1,181	$34.18	$34.39	11
Louisiana	1,085	$34.39	$34.39	13
Oregon	960	$34.23	$34.39	7
Wisconsin	846	$33.30	$34.39	4
Arkansas	765	$34.39	$34.39	6
Mississippi	746	$34.32	$34.39	9
Nebraska	697	$34.27	$34.39	12
Virginia	602	$34.15	$34.39	7
Puerto Rico	477	$34.21	$34.39	6
Minnesota	454	$34.09	$34.39	5
Hawaii	428	$34.35	$34.39	2
Indiana	380	$34.31	$34.39	5
Kentucky	362	$34.23	$34.39	4
South Carolina	281	$34.27	$34.39	4
New Mexico	249	$34.13	$34.39	3
Rhode Island	167	$34.39	$34.39	2
Iowa	151	$34.39	$34.39	3
New Hampshire	140	$34.14	$34.39	1
Connecticut	107	$33.56	$34.39	3
U.S. Virgin Islands	76	$34.11	$34.39	2
Maine	64	$34.39	$34.39	1
Delaware	61	$34.39	$34.39	4
South Dakota	41	$34.39	$34.39	1
Idaho	24	$32.96	$34.39	1
Montana	24	$34.39	$34.39	1
North Dakota	15	$34.39	$34.39	1

Related codes

87481Detection test for candida species (yeast)$34.05
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
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.