How much does Medicare pay for CPT 87505?

Medicare allowed an average of $125.17 per service and paid $125.17 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $294.10, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 87505?

Detection test by nucleic acid for digestive tract pathogen, multiple types or subtypes, 3-5 targets. It was billed 8,147 times to 7,223 Medicare beneficiaries by 65 providers in 2024.

Which specialty bills 87505 most?

Clinical Laboratory, with 7,494 services from 52 clinicians. Next are Pathology, Nurse Practitioner, Physician Assistant.

CPT 87505

Detection test by nucleic acid for digestive tract pathogen, multiple types or subtypes, 3-5 targets

$125.17Medicare-allowed amount per service, averaged across 8,147 services

Providers submitted

$294.10

Asking price, not received

Medicare allowed

$125.17

The fee schedule figure

Medicare paid

$125.17

Balance is patient coinsurance

Providers submitted an average of $294.10 for this code and Medicare allowed $125.17 — 2.3× 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 $125.17 (100%); the rest is the patient’s coinsurance and deductible.

Services: 8,147
Beneficiaries: 7,223
Providers billing it: 65
Total allowed: $1,019,760

What Medicare pays for CPT 87505

Across 8,147 services billed by 65 providers to 7,223 beneficiaries, Medicare allowed an average of $125.17 per service. 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 87505

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	7,494	6,588	$125.16	52
Pathology	538	520	$125.20	6
Nurse Practitioner	77	77	$125.72	5
Physician Assistant	38	38	$125.72	2

87505 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
California	3,497	$125.03	$125.38	9
Pennsylvania	913	$125.49	$125.72	3
Tennessee	601	$125.43	$125.72	9
New Jersey	350	$124.99	$125.72	4
Iowa	328	$124.80	$125.72	2
Wisconsin	325	$124.64	$125.72	2
New Mexico	290	$125.72	$125.72	1
Ohio	205	$125.72	$125.72	2
Washington	200	$125.05	$125.72	1
Texas	180	$125.72	$125.72	3
Indiana	148	$125.72	$125.72	2
Louisiana	107	$125.72	$125.72	1
Mississippi	96	$125.72	$125.72	1
North Carolina	95	$125.72	$125.72	4
Oregon	93	$125.72	$125.72	1
Virginia	92	$124.80	$125.72	2
Colorado	91	$125.72	$125.72	3
Maine	84	$125.72	$125.72	1
Minnesota	78	$123.37	$125.72	1
Florida	75	$124.26	$125.72	2
Kansas	68	$125.72	$125.72	1
Idaho	55	$125.72	$125.72	1
New York	35	$125.72	$125.72	2
Alabama	30	$125.72	$125.72	1
Michigan	29	$125.72	$125.72	1
Georgia	20	$118.78	$125.72	1
Arizona	16	$119.86	$125.72	1
Oklahoma	16	$125.72	$125.72	1
Nebraska	15	$125.72	$125.72	1
Illinois	15	$125.72	$125.72	1

Related codes

87500Detection test by nucleic acid for vancomycin resistance strep (vre)$34.35
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

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.