How much does Medicare pay for CPT 87522?

Medicare allowed an average of $41.95 per service and paid $41.95 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $509.00, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 87522?

Detection test by nucleic acid for hepatitis c virus, quantification. It was billed 65,425 times to 56,835 Medicare beneficiaries by 192 providers in 2024.

Which specialty bills 87522 most?

Clinical Laboratory, with 64,152 services from 164 clinicians. Next are Pathology, Internal Medicine, Family Practice.

CPT 87522

Detection test by nucleic acid for hepatitis c virus, quantification

$41.95Medicare-allowed amount per service, averaged across 65,425 services

Providers submitted

$509.00

Asking price, not received

Medicare allowed

$41.95

The fee schedule figure

Medicare paid

$41.95

Balance is patient coinsurance

Providers submitted an average of $509.00 for this code and Medicare allowed $41.95 — 12.1× 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 $41.95 (100%); the rest is the patient’s coinsurance and deductible.

Services: 65,425
Beneficiaries: 56,835
Providers billing it: 192
Total allowed: $2,744,579

What Medicare pays for CPT 87522

Across 65,425 services billed by 192 providers to 56,835 beneficiaries, Medicare allowed an average of $41.95 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 87522

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	64,152	55,619	$41.95	164
Pathology	799	758	$41.89	5
Internal Medicine	222	213	$41.98	11
Family Practice	133	128	$41.98	6
Nurse Practitioner	72	71	$41.98	4
General Practice	32	32	$41.98	1
Pediatric Medicine	15	14	$41.98	1

87522 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	12,929	$41.97	$41.98	55
New Jersey	9,766	$41.96	$41.98	9
North Carolina	7,965	$41.96	$41.98	4
Florida	7,246	$41.94	$42.01	9
Texas	5,059	$41.97	$41.98	11
Arizona	2,809	$41.91	$41.98	3
Georgia	1,981	$41.98	$41.98	1
Massachusetts	1,727	$41.97	$41.98	6
Illinois	1,609	$41.98	$41.98	3
New York	1,532	$41.98	$41.98	7
Kansas	1,408	$41.98	$41.98	4
Ohio	1,286	$41.98	$41.98	6
Alabama	1,239	$41.94	$41.98	3
Tennessee	1,016	$41.91	$41.98	4
Maryland	994	$41.95	$41.98	5
Pennsylvania	811	$41.94	$41.98	7
Washington	735	$41.98	$41.98	4
Oklahoma	687	$41.88	$41.98	4
Nevada	520	$41.83	$41.98	2
Mississippi	514	$41.98	$41.98	2
Minnesota	496	$41.77	$41.98	5
Virginia	457	$41.91	$41.98	5
Oregon	391	$41.68	$41.98	3
Colorado	377	$41.98	$41.98	4
Michigan	360	$41.98	$41.98	6
Hawaii	294	$41.80	$41.98	2
Wisconsin	284	$40.96	$41.98	2
Kentucky	220	$41.98	$41.98	4
New Mexico	176	$41.98	$41.98	1
Maine	135	$41.98	$41.98	1
Indiana	107	$41.98	$41.98	2
Rhode Island	81	$41.98	$41.98	2
South Dakota	70	$41.98	$41.98	1
Utah	61	$41.98	$41.98	2
Iowa	39	$41.98	$41.98	1
Louisiana	24	$41.98	$41.98	1
Connecticut	20	$41.98	$41.98	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
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.