How much does Medicare pay for CPT 87497?

Medicare allowed an average of $41.82 per service and paid $41.82 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $445.16, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 87497?

Detection test by nucleic acid for cytomegalovirus, quantification. It was billed 91,684 times to 23,387 Medicare beneficiaries by 104 providers in 2024.

Which specialty bills 87497 most?

Clinical Laboratory, with 91,101 services from 93 clinicians. Next are Pathology, Family Practice, Internal Medicine.

CPT 87497

Detection test by nucleic acid for cytomegalovirus, quantification

$41.82Medicare-allowed amount per service, averaged across 91,684 services

Providers submitted

$445.16

Asking price, not received

Medicare allowed

$41.82

The fee schedule figure

Medicare paid

$41.82

Balance is patient coinsurance

Providers submitted an average of $445.16 for this code and Medicare allowed $41.82 — 10.6× 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 $41.82 (100%); the rest is the patient’s coinsurance and deductible.

Services: 91,684
Beneficiaries: 23,387
Providers billing it: 104
Total allowed: $3,834,225

What Medicare pays for CPT 87497

Across 91,684 services billed by 104 providers to 23,387 beneficiaries, Medicare allowed an average of $41.82 per service. That is 3.9 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 87497

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	91,101	23,190	$41.82	93
Pathology	329	115	$41.77	5
Family Practice	213	71	$40.79	5
Internal Medicine	41	11	$41.98	1

87497 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
New Jersey	15,106	$41.95	$41.98	3
California	14,485	$41.96	$41.98	16
Florida	11,782	$41.81	$41.98	5
North Carolina	9,863	$41.87	$41.98	2
Texas	7,023	$41.86	$41.98	9
Arizona	4,533	$41.71	$41.98	2
New York	3,782	$41.92	$41.98	3
Massachusetts	2,614	$41.88	$41.98	3
Kansas	2,583	$41.88	$41.98	4
Ohio	2,146	$41.73	$41.98	4
Minnesota	2,090	$41.72	$41.98	11
Alabama	1,798	$41.98	$41.98	1
Wisconsin	1,770	$39.52	$41.98	2
Pennsylvania	1,687	$41.87	$41.98	4
Georgia	1,457	$41.98	$41.98	1
Washington	1,414	$41.89	$41.98	5
Virginia	1,367	$41.39	$41.98	3
Illinois	1,087	$41.98	$41.98	1
Maryland	1,055	$41.98	$41.98	1
Nevada	843	$41.87	$41.98	1
Hawaii	613	$41.17	$41.98	2
Oklahoma	563	$41.85	$41.98	3
Tennessee	445	$41.98	$41.98	3
Oregon	381	$41.71	$41.98	3
Colorado	325	$40.68	$41.98	3
New Mexico	234	$41.66	$41.98	1
Iowa	128	$41.72	$41.98	1
Maine	122	$41.45	$41.98	1
South Dakota	112	$41.98	$41.98	1
Michigan	88	$41.98	$41.98	2
Utah	87	$41.98	$41.98	1
Kentucky	62	$36.60	$41.98	1
Indiana	39	$41.98	$41.98	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
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.