How much does Medicare pay for CPT 87563?

Medicare allowed an average of $34.36 per service and paid $34.36 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $63.54, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 87563?

Detection of mycoplasma genitalium by dna or rna probe. It was billed 175,000 times to 121,083 Medicare beneficiaries by 309 providers in 2024.

Which specialty bills 87563 most?

Clinical Laboratory, with 147,174 services from 204 clinicians. Next are Pathology, Urology, Physician Assistant.

CPT 87563

Detection of mycoplasma genitalium by dna or rna probe

$34.36Medicare-allowed amount per service, averaged across 175,000 services

Providers submitted

$63.54

Asking price, not received

Medicare allowed

$34.36

The fee schedule figure

Medicare paid

$34.36

Balance is patient coinsurance

Providers submitted an average of $63.54 for this code and Medicare allowed $34.36 — 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 $34.36 (100%); the rest is the patient’s coinsurance and deductible.

Services: 175,000
Beneficiaries: 121,083
Providers billing it: 309
Total allowed: $6,013,000

What Medicare pays for CPT 87563

Across 175,000 services billed by 309 providers to 121,083 beneficiaries, Medicare allowed an average of $34.36 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 87563

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	147,174	99,436	$34.37	204
Pathology	18,015	15,169	$34.27	25
Urology	6,888	4,233	$34.32	42
Physician Assistant	904	761	$34.24	14
Obstetrics & Gynecology	813	677	$34.35	12
Nurse Practitioner	557	390	$34.13	7
Internal Medicine	327	170	$34.39	1
Hematology-Oncology	194	152	$34.25	1
Family Practice	104	77	$34.39	2
General Practice	24	18	$34.39	1

87563 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	39,614	$34.37	$34.39	67
Pennsylvania	29,593	$34.38	$34.39	10
Florida	25,910	$34.37	$34.39	26
New Jersey	14,787	$34.33	$34.39	16
Arizona	11,109	$34.37	$34.39	7
Maryland	10,498	$34.39	$34.39	4
New York	8,279	$34.34	$34.39	17
Oklahoma	5,669	$34.33	$34.39	16
Missouri	4,259	$34.36	$34.39	6
Colorado	4,112	$34.39	$34.39	11
California	3,924	$34.37	$34.39	21
Louisiana	2,902	$34.35	$34.39	7
Illinois	2,270	$34.35	$34.39	15
Michigan	2,148	$34.28	$34.39	6
Nevada	1,888	$33.98	$34.39	5
Tennessee	1,414	$34.39	$34.39	12
North Carolina	973	$34.30	$34.39	2
Utah	747	$34.39	$34.39	2
Mississippi	637	$34.39	$34.39	8
Kansas	585	$34.34	$34.39	5
Ohio	579	$34.39	$34.39	2
Arkansas	467	$34.32	$34.39	2
Virginia	447	$34.47	$34.39	5
Nebraska	419	$34.26	$34.39	11
Massachusetts	375	$34.36	$34.39	3
Indiana	335	$34.39	$34.39	2
Washington	270	$34.18	$34.39	5
Connecticut	202	$34.39	$34.39	1
Kentucky	116	$34.39	$34.39	1
Wisconsin	96	$32.75	$34.39	2
New Mexico	71	$34.00	$34.39	1
Puerto Rico	64	$34.39	$34.39	2
Minnesota	60	$34.39	$34.39	3
Georgia	56	$34.39	$34.39	1
Alabama	52	$34.09	$34.39	2
Rhode Island	45	$34.39	$34.39	1
West Virginia	17	$34.39	$34.39	1
South Dakota	11	$34.39	$34.39	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
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.