How much does Medicare pay for CPT 87506?

Medicare allowed an average of $257.29 per service and paid $257.29 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $553.33, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 87506?

Detection test by nucleic acid for digestive tract pathogen, multiple types or subtypes, 6-11 targets. It was billed 34,778 times to 33,306 Medicare beneficiaries by 96 providers in 2024.

Which specialty bills 87506 most?

Clinical Laboratory, with 20,860 services from 72 clinicians. Next are Pathology, Gastroenterology, Physician Assistant.

CPT 87506

Detection test by nucleic acid for digestive tract pathogen, multiple types or subtypes, 6-11 targets

$257.29Medicare-allowed amount per service, averaged across 34,778 services

Providers submitted

$553.33

Asking price, not received

Medicare allowed

$257.29

The fee schedule figure

Medicare paid

$257.29

Balance is patient coinsurance

Providers submitted an average of $553.33 for this code and Medicare allowed $257.29 — 2.2× 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 $257.29 (100%); the rest is the patient’s coinsurance and deductible.

Services: 34,778
Beneficiaries: 33,306
Providers billing it: 96
Total allowed: $8,948,032

What Medicare pays for CPT 87506

Across 34,778 services billed by 96 providers to 33,306 beneficiaries, Medicare allowed an average of $257.29 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 87506

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	20,860	19,819	$257.21	72
Pathology	13,614	13,205	$257.43	9
Gastroenterology	284	265	$256.99	14
Physician Assistant	20	17	$257.73	1

87506 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	19,816	$257.44	$257.73	13
Arkansas	5,857	$257.32	$257.73	3
Maryland	2,018	$256.52	$257.73	4
Tennessee	1,418	$257.28	$257.73	1
Florida	1,272	$257.22	$257.73	11
Texas	1,084	$256.72	$257.73	15
Pennsylvania	893	$257.53	$257.73	12
Arizona	665	$257.71	$257.73	1
Colorado	354	$254.57	$255.40	4
Illinois	331	$257.73	$257.73	3
Minnesota	237	$256.64	$257.73	3
New York	184	$256.46	$257.73	5
Mississippi	147	$256.66	$257.73	4
California	105	$257.73	$257.73	3
South Carolina	91	$257.73	$257.73	1
Oklahoma	70	$257.73	$257.73	3
Louisiana	59	$257.53	$257.73	2
Wisconsin	56	$257.73	$257.73	2
Kansas	28	$251.21	$257.73	1
Massachusetts	24	$257.73	$257.73	1
Washington	22	$257.73	$257.73	1
Virginia	20	$257.73	$257.73	1
North Carolina	16	$257.73	$257.73	1
Georgia	11	$257.73	$257.73	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.