How much does Medicare pay for CPT 87581?

Medicare allowed an average of $34.37 per service and paid $34.37 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $51.88, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 87581?

Detection test by nucleic acid for mycoplasma pneumoniae (bacteria), amplified probe technique. It was billed 276,446 times to 213,589 Medicare beneficiaries by 362 providers in 2024.

Which specialty bills 87581 most?

Clinical Laboratory, with 270,688 services from 268 clinicians. Next are Family Practice, Internal Medicine, Nurse Practitioner.

CPT 87581

Detection test by nucleic acid for mycoplasma pneumoniae (bacteria), amplified probe technique

$34.37Medicare-allowed amount per service, averaged across 276,446 services

Providers submitted

$51.88

Asking price, not received

Medicare allowed

$34.37

The fee schedule figure

Medicare paid

$34.37

Balance is patient coinsurance

Providers submitted an average of $51.88 for this code and Medicare allowed $34.37 — 1.5× 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 $34.37 (100%); the rest is the patient’s coinsurance and deductible.

Services: 276,446
Beneficiaries: 213,589
Providers billing it: 362
Total allowed: $9,501,449

What Medicare pays for CPT 87581

Across 276,446 services billed by 362 providers to 213,589 beneficiaries, Medicare allowed an average of $34.37 per service. That is 1.3 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 87581

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	270,688	208,649	$34.38	268
Family Practice	2,038	1,699	$34.22	25
Internal Medicine	1,713	1,414	$34.34	22
Nurse Practitioner	1,246	1,108	$34.23	29
Hematology-Oncology	190	180	$34.23	1
Pathology	118	115	$34.39	5
Emergency Medicine	110	104	$34.39	3
Pulmonary Disease	99	92	$34.39	2
Physician Assistant	86	84	$34.39	4
General Practice	64	64	$34.39	1
Cardiology	48	42	$34.39	1
General Surgery	46	38	$34.39	1

87581 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	104,847	$34.37	$34.39	79
California	80,830	$34.38	$34.39	61
Arizona	14,403	$34.39	$34.39	3
Florida	13,020	$34.39	$34.39	47
New York	12,959	$34.38	$34.39	8
Colorado	10,295	$34.39	$34.39	7
Illinois	7,934	$34.39	$34.39	14
Pennsylvania	7,458	$34.39	$34.39	11
New Jersey	6,671	$34.39	$34.39	17
Oklahoma	5,522	$34.31	$34.39	8
Mississippi	2,635	$34.32	$34.39	25
Missouri	1,978	$34.36	$34.39	1
Louisiana	1,447	$34.34	$34.39	16
Arkansas	1,205	$34.39	$34.39	4
Indiana	676	$34.39	$34.39	2
Maryland	626	$34.39	$34.39	2
North Carolina	605	$34.39	$34.39	3
Virginia	513	$34.39	$34.39	3
New Mexico	365	$34.12	$34.39	6
Alabama	338	$31.47	$34.39	3
Ohio	273	$34.39	$34.39	3
Utah	253	$34.39	$34.39	1
Iowa	252	$34.39	$34.39	9
Washington	237	$34.14	$34.39	8
Minnesota	198	$34.39	$34.39	1
Nevada	181	$34.39	$34.39	2
Connecticut	177	$34.39	$34.39	2
Kentucky	148	$34.39	$34.39	1
Nebraska	138	$34.39	$34.39	5
Delaware	75	$34.39	$34.39	1
Michigan	52	$34.39	$34.39	2
District of Columbia	46	$34.39	$34.39	1
Oregon	39	$34.39	$34.39	2
Tennessee	26	$33.21	$34.39	2
Georgia	13	$34.39	$34.39	1
Montana	11	$34.39	$34.39	1

Related codes

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