How much does Medicare pay for CPT 87493?

Medicare allowed an average of $36.38 per service and paid $36.38 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $121.20, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 87493?

Detection test by nucleic acid for clostridium difficile, amplified probe technique. It was billed 89,869 times to 77,409 Medicare beneficiaries by 289 providers in 2024.

Does 87493 pay differently in an office than a hospital?

Yes. The allowed amount averaged $36.38 in an office setting and $36.52 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 87493 most?

Clinical Laboratory, with 85,791 services from 237 clinicians. Next are Pathology, Gastroenterology, Family Practice.

CPT 87493

Detection test by nucleic acid for clostridium difficile, amplified probe technique

$36.38Medicare-allowed amount per service, averaged across 89,869 services

Providers submitted

$121.20

Asking price, not received

Medicare allowed

$36.38

The fee schedule figure

Medicare paid

$36.38

Balance is patient coinsurance

Providers submitted an average of $121.20 for this code and Medicare allowed $36.38 — 3.3× 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 $36.38 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $36.38
Hospital / facility: $36.52

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 89,816 services were billed in an office setting and 53 in a facility.

Services: 89,869
Beneficiaries: 77,409
Providers billing it: 289
Total allowed: $3,269,434

What Medicare pays for CPT 87493

Across 89,869 services billed by 289 providers to 77,409 beneficiaries, Medicare allowed an average of $36.38 per service. That is 1.2 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 87493

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	85,791	73,866	$36.38	237
Pathology	2,501	2,330	$36.29	12
Gastroenterology	734	561	$36.18	17
Family Practice	243	212	$36.37	3
Nurse Practitioner	225	168	$36.17	7
Internal Medicine	195	114	$35.39	7
Physician Assistant	70	63	$36.52	3
Hematology-Oncology	65	63	$36.52	1
Emergency Medicine	23	11	$36.52	1
General Practice	22	21	$36.52	1

87493 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
Pennsylvania	17,758	$36.51	$36.52	12
Florida	6,908	$36.48	$36.52	16
California	6,721	$35.49	$36.51	33
New Jersey	6,621	$36.47	$36.52	10
Texas	6,591	$36.49	$36.52	27
North Carolina	5,225	$36.50	$36.52	3
New York	3,704	$36.48	$36.52	13
Ohio	3,104	$36.46	$36.52	12
Virginia	2,975	$36.48	$36.52	7
Kansas	2,758	$36.51	$36.52	8
Illinois	2,700	$35.94	$36.52	25
Massachusetts	2,565	$36.50	$36.52	10
Arizona	2,467	$36.42	$36.52	6
Tennessee	2,150	$36.40	$36.52	9
Wisconsin	1,940	$36.11	$36.52	4
Washington	1,820	$36.45	$36.52	7
Alabama	1,495	$36.45	$36.52	3
Nevada	1,301	$36.45	$36.52	3
Maryland	1,151	$36.36	$36.52	7
Georgia	1,030	$36.45	$36.52	3
Oregon	986	$36.35	$36.52	7
Minnesota	827	$36.15	$36.48	6
Hawaii	825	$36.46	$36.52	2
Missouri	674	$36.38	$36.47	3
Colorado	624	$36.42	$36.52	5
Mississippi	620	$36.48	$36.52	3
Iowa	581	$36.52	$36.52	4
South Dakota	536	$36.52	$36.52	3
Kentucky	507	$36.37	$36.52	4
Louisiana	436	$36.52	$36.52	4
Indiana	427	$36.28	$36.52	4
Oklahoma	366	$36.44	$36.52	3
North Dakota	254	$36.08	$36.52	3
Maine	252	$36.42	$36.52	1
Utah	241	$36.19	$36.52	8
Nebraska	167	$36.52	$36.52	1
Michigan	133	$36.52	$36.52	2
New Mexico	120	$36.52	$36.52	1
Arkansas	104	$36.52	$36.52	1
Montana	82	$36.52	$36.52	1
Rhode Island	45	$36.52	$36.52	1
Delaware	28	$36.52	$36.52	1
Connecticut	25	$36.52	$36.52	1
West Virginia	14	$36.52	$36.52	1
Idaho	11	$36.52	$36.52	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
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
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.