How much does Medicare pay for CPT 87500?

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 $63.16, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 87500?

Detection test by nucleic acid for vancomycin resistance strep (vre), amplified probe technique. It was billed 629,864 times to 444,244 Medicare beneficiaries by 926 providers in 2024.

Does 87500 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 87500 most?

Clinical Laboratory, with 544,616 services from 375 clinicians. Next are Urology, Pathology, Nurse Practitioner.

CPT 87500

Detection test by nucleic acid for vancomycin resistance strep (vre), amplified probe technique

$34.35Medicare-allowed amount per service, averaged across 629,864 services

Providers submitted

$63.16

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 $63.16 for this code and Medicare allowed $34.35 — 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 $34.35 (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. 629,823 services were billed in an office setting and 41 in a facility.

Services: 629,864
Beneficiaries: 444,244
Providers billing it: 926
Total allowed: $21,635,828

What Medicare pays for CPT 87500

Across 629,864 services billed by 926 providers to 444,244 beneficiaries, Medicare allowed an average of $34.35 per service. That is 1.4 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 87500

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	544,616	384,389	$34.37	375
Urology	40,948	26,430	$34.29	312
Pathology	26,003	19,468	$34.00	34
Nurse Practitioner	4,968	3,989	$34.31	76
Podiatry	3,951	2,859	$34.36	42
Physician Assistant	3,396	2,550	$34.32	40
Internal Medicine	2,897	2,058	$34.37	16
Family Practice	1,264	1,056	$34.37	13
Obstetrics & Gynecology	760	572	$34.24	10
Undersea and Hyperbaric Medicine	419	319	$33.77	1
Hematology-Oncology	387	330	$34.15	1
Emergency Medicine	217	192	$34.24	4
General Practice	25	19	$33.29	1
Interventional Pain Management	13	13	$34.39	1

87500 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	182,187	$34.37	$34.39	211
Florida	77,648	$34.33	$34.39	91
Pennsylvania	66,886	$34.39	$34.39	27
California	46,987	$34.39	$34.39	53
Arizona	25,082	$34.37	$34.39	7
Arkansas	22,667	$34.33	$34.39	28
New Jersey	21,488	$34.38	$34.39	31
Louisiana	21,150	$34.38	$34.39	23
Illinois	20,464	$34.35	$34.39	43
Maryland	17,477	$34.35	$34.39	47
Colorado	16,994	$34.38	$34.39	41
New York	16,600	$34.33	$34.39	21
Mississippi	16,474	$34.37	$34.39	41
Oklahoma	13,636	$34.35	$34.39	24
Indiana	10,185	$34.39	$34.39	3
Georgia	9,261	$34.38	$34.39	11
North Carolina	8,677	$34.38	$34.38	8
Virginia	6,558	$34.37	$34.39	14
Missouri	6,451	$33.10	$34.39	26
Massachusetts	3,942	$34.36	$34.39	35
Utah	3,834	$34.39	$34.39	5
Alabama	3,044	$33.70	$34.39	10
Kansas	2,994	$34.36	$34.39	16
Michigan	2,829	$34.28	$34.39	8
Ohio	1,285	$34.39	$34.39	8
Connecticut	736	$34.39	$34.39	5
Wyoming	710	$34.14	$34.39	7
Nebraska	670	$34.31	$34.39	11
Iowa	488	$34.33	$34.39	7
South Carolina	481	$33.41	$34.39	5
New Hampshire	473	$34.32	$34.39	14
Tennessee	333	$33.95	$34.39	10
New Mexico	253	$34.16	$34.39	5
Rhode Island	248	$34.13	$34.39	9
Idaho	209	$34.39	$34.39	7
Kentucky	159	$34.39	$34.39	4
Nevada	155	$34.39	$34.39	2
Maine	47	$34.39	$34.39	1
Washington	44	$34.39	$34.39	3
Oregon	35	$34.39	$34.39	2
Minnesota	12	$34.39	$34.39	1
Delaware	11	$34.39	$34.39	1

Related codes

87581Detection test by nucleic acid for mycoplasma pneumoniae (bacteria)$34.37
87591Detection test by nucleic acid for neisseria gonorrhoeae (gonorrhoeae$34.35
87502Detection test by nucleic acid for multiple types influenza virus$92.99
87529Detection test by nucleic acid for herpes simplex virus$34.33
87563Detection of mycoplasma genitalium by dna or rna probe$34.36
87541Detection test by nucleic acid for legionella pneumophila (water borne$34.38
87556Detection test by nucleic acid for mycobacteria tuberculosis (tb bacte$40.79
87511Detection test for gardnerella vaginalis (bacteria)$34.34
87536Detection test by nucleic acid for hiv-1 virus$83.30
87522Detection test by nucleic acid for hepatitis c virus$41.95
87532Detection test by nucleic acid for herpes virus-6$34.38
87517Detection test by nucleic acid for hepatitis b virus$41.93

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.