How much does Medicare pay for CPT 87536?

Medicare allowed an average of $83.30 per service and paid $83.30 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $448.63, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 87536?

Detection test by nucleic acid for hiv-1 virus, quantification. It was billed 80,106 times to 44,306 Medicare beneficiaries by 154 providers in 2024.

Does 87536 pay differently in an office than a hospital?

Yes. The allowed amount averaged $83.30 in an office setting and $83.40 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 87536 most?

Clinical Laboratory, with 78,364 services from 127 clinicians. Next are Infectious Disease, Pathology, Family Practice.

CPT 87536

Detection test by nucleic acid for hiv-1 virus, quantification

$83.30Medicare-allowed amount per service, averaged across 80,106 services

Providers submitted

$448.63

Asking price, not received

Medicare allowed

$83.30

The fee schedule figure

Medicare paid

$83.30

Balance is patient coinsurance

Providers submitted an average of $448.63 for this code and Medicare allowed $83.30 — 5.4× 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 $83.30 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $83.30
Hospital / facility: $83.40

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 80,073 services were billed in an office setting and 33 in a facility.

Services: 80,106
Beneficiaries: 44,306
Providers billing it: 154
Total allowed: $6,672,830

What Medicare pays for CPT 87536

Across 80,106 services billed by 154 providers to 44,306 beneficiaries, Medicare allowed an average of $83.30 per service. That is 1.8 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 87536

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	78,364	43,351	$83.31	127
Infectious Disease	695	315	$82.75	6
Pathology	333	230	$82.70	5
Family Practice	264	171	$83.08	5
Internal Medicine	258	133	$83.12	6
Nurse Practitioner	167	84	$83.40	4
Hematology-Oncology	25	22	$83.40	1

87536 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	14,488	$83.34	$83.40	35
New Jersey	11,588	$83.29	$83.40	6
North Carolina	10,961	$83.30	$83.40	4
Florida	10,956	$83.32	$83.40	9
Texas	6,846	$83.38	$83.40	8
Arizona	3,779	$83.15	$83.40	2
Georgia	2,709	$83.37	$83.40	8
Maryland	2,391	$83.30	$83.40	5
Massachusetts	1,991	$83.40	$83.40	9
Alabama	1,896	$83.34	$83.40	1
Kansas	1,783	$83.33	$83.40	3
Ohio	1,709	$83.31	$83.40	5
Illinois	1,639	$83.36	$83.40	3
New York	1,016	$83.40	$83.40	4
Washington	755	$83.39	$83.40	4
Pennsylvania	743	$83.27	$83.40	5
Tennessee	724	$83.00	$83.40	5
Oklahoma	530	$82.60	$83.40	4
Nevada	439	$83.24	$83.40	2
Virginia	426	$83.40	$83.40	3
Wisconsin	409	$82.58	$83.40	2
Minnesota	382	$82.83	$83.40	4
Oregon	328	$83.40	$83.40	3
Hawaii	287	$83.25	$83.40	2
Indiana	271	$83.17	$83.40	1
Michigan	252	$83.14	$83.40	2
Louisiana	128	$83.40	$83.40	1
Maine	110	$82.82	$83.40	1
Colorado	108	$83.40	$83.40	2
Utah	85	$83.40	$83.40	2
Iowa	70	$83.40	$83.40	2
Puerto Rico	60	$80.20	$83.40	2
Connecticut	59	$82.38	$83.40	1
Kentucky	58	$83.40	$83.40	1
South Dakota	49	$83.40	$83.40	1
New Mexico	44	$83.40	$83.40	1
Wyoming	37	$83.40	$83.40	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
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.