How much does Medicare pay for CPT 87635?

Medicare allowed an average of $50.11 per service and paid $50.11 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $126.39, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 87635?

Amplifed dna or rna probe detection of severe acute respiratory syndrome coronavirus 2 (covid-19) antigen. It was billed 798,991 times to 488,654 Medicare beneficiaries by 8,131 providers in 2024.

Does 87635 pay differently in an office than a hospital?

Yes. The allowed amount averaged $50.11 in an office setting and $50.28 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 87635 most?

Clinical Laboratory, with 513,957 services from 458 clinicians. Next are Nurse Practitioner, Family Practice, Physician Assistant.

CPT 87635

Amplifed dna or rna probe detection of severe acute respiratory syndrome coronavirus 2 (covid-19) antigen

$50.11Medicare-allowed amount per service, averaged across 798,991 services

Providers submitted

$126.39

Asking price, not received

Medicare allowed

$50.11

The fee schedule figure

Medicare paid

$50.11

Balance is patient coinsurance

Providers submitted an average of $126.39 for this code and Medicare allowed $50.11 — 2.5× 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 $50.11 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $50.11
Hospital / facility: $50.28

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 798,674 services were billed in an office setting and 317 in a facility.

Services: 798,991
Beneficiaries: 488,654
Providers billing it: 8,131
Total allowed: $40,037,439

What Medicare pays for CPT 87635

Across 798,991 services billed by 8,131 providers to 488,654 beneficiaries, Medicare allowed an average of $50.11 per service. That is 1.6 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 87635

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	513,957	239,408	$50.24	458
Nurse Practitioner	84,001	79,800	$49.81	2,620
Family Practice	78,055	63,585	$49.78	1,965
Physician Assistant	53,370	51,923	$49.91	1,689
Internal Medicine	39,480	27,459	$49.99	836
Emergency Medicine	13,890	13,133	$50.00	342
Pathology	6,255	5,509	$50.07	28
General Practice	2,000	1,725	$49.88	48
Pulmonary Disease	1,241	1,107	$50.04	26
Geriatric Medicine	1,123	901	$50.06	20
Anesthesiology	1,077	517	$50.28	1
Cardiology	609	602	$50.13	12
Pain Management	469	156	$49.45	1
Obstetrics & Gynecology	423	276	$50.23	5
Hospitalist	322	291	$50.16	11

87635 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	259,530	$50.26	$50.28	784
Texas	77,123	$50.16	$50.24	331
New York	53,060	$50.13	$50.28	476
New Jersey	52,354	$50.23	$50.28	122
Illinois	51,791	$50.22	$50.28	476
North Carolina	28,893	$49.99	$50.26	580
Pennsylvania	23,380	$50.21	$50.28	218
Florida	23,178	$50.06	$50.28	175
Tennessee	22,863	$49.77	$50.28	567
Arizona	21,189	$50.22	$50.28	84
South Carolina	15,938	$49.62	$50.28	394
Massachusetts	12,234	$50.11	$50.28	290
Georgia	11,149	$49.57	$50.28	249
Mississippi	10,683	$49.14	$50.28	264
Missouri	10,510	$49.90	$50.28	179
Ohio	9,755	$49.86	$50.28	334
Indiana	9,556	$49.89	$50.28	258
Colorado	8,192	$50.18	$50.28	63
Virginia	8,063	$50.07	$50.27	181
Alabama	7,405	$49.65	$50.19	170
Maryland	6,460	$50.21	$50.28	76
Kentucky	6,424	$49.64	$50.28	172
Michigan	5,712	$49.90	$50.25	131
Washington	5,688	$49.74	$50.28	216
Oklahoma	5,620	$50.06	$50.28	102
Minnesota	5,307	$49.97	$50.28	99
Arkansas	5,102	$49.80	$50.28	141
Louisiana	4,551	$49.59	$50.18	97
Iowa	4,208	$49.86	$50.28	96
Kansas	3,887	$50.13	$50.28	130
Hawaii	3,490	$49.91	$50.28	33
Wisconsin	3,390	$50.07	$50.28	27
Connecticut	3,186	$50.10	$50.28	124
Utah	2,849	$50.04	$50.28	38
Nevada	2,419	$50.15	$50.28	15
Nebraska	2,383	$49.98	$50.26	73
Oregon	2,312	$49.80	$50.28	80
Montana	1,621	$50.03	$50.28	46
New Mexico	1,620	$49.39	$50.28	57
South Dakota	1,209	$50.06	$50.28	43
Idaho	1,024	$49.99	$50.28	33
Alaska	655	$50.08	$50.28	26
Puerto Rico	548	$50.19	$50.28	9
Maine	441	$50.17	$50.28	6
Delaware	375	$50.15	$50.28	12
Rhode Island	361	$49.76	$50.28	8
West Virginia	268	$49.69	$50.28	15
New Hampshire	268	$50.28	$50.28	3
North Dakota	204	$49.89	$50.28	4
Wyoming	163	$50.28	$50.28	8
Vermont	163	$50.28	$50.28	10
District of Columbia	111	$50.28	$50.28	4
AE	82	$50.28	$50.28	1
U.S. Virgin Islands	44	$48.16	$49.33	1

Related codes

87640Detection test by nucleic acid for staphylococcus aureus (bacteria)$34.35
87653Detection test by nucleic acid for strep (streptococcus$34.36
87651Detection test by nucleic acid for strep (streptococcus$34.33
87641Detection test by nucleic acid for staphylococcus aureus$34.36
87637Detection test by multiplex amplified probe technique for severe acute$139.09
87631Detection test by nucleic acid for multiple types of respiratory virus$139.46
87624Detection test by nucleic acid for human papillomavirus (hpv)$34.30
87636Detection test by multiplex amplified probe technique for severe acute$138.39
87661Detection test by nucleic acid for trichomonas vaginalis (genital para$34.30
87634Detection test by nucleic acid for respiratory syncytial virus$68.72
87652Detection test by nucleic acid for strep (streptococcus$40.89
87625Detection test by nucleic acid for human papillomavirus (hpv)$39.71

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.