How much does Medicare pay for CPT 87636?

Medicare allowed an average of $138.39 per service and paid $138.39 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $295.67, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does 87636 pay differently in an office than a hospital?

Yes. The allowed amount averaged $138.39 in an office setting and $139.78 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 87636 most?

Clinical Laboratory, with 119,295 services from 119 clinicians. Next are Nurse Practitioner, Family Practice, Physician Assistant.

CPT 87636

Detection test by multiplex amplified probe technique for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (covid-19) and influenza virus types a and b

$138.39Medicare-allowed amount per service, averaged across 198,171 services

Providers submitted

$295.67

Asking price, not received

Medicare allowed

$138.39

The fee schedule figure

Medicare paid

$138.39

Balance is patient coinsurance

Providers submitted an average of $295.67 for this code and Medicare allowed $138.39 — 2.1× 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 $138.39 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $138.39
Hospital / facility: $139.78

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 198,146 services were billed in an office setting and 25 in a facility.

Services: 198,171
Beneficiaries: 102,493
Providers billing it: 2,407
Total allowed: $27,424,885

What Medicare pays for CPT 87636

Across 198,171 services billed by 2,407 providers to 102,493 beneficiaries, Medicare allowed an average of $138.39 per service. That is 1.9 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 87636

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	119,295	28,218	$139.71	119
Nurse Practitioner	27,010	25,924	$136.43	853
Family Practice	18,398	16,715	$136.43	506
Physician Assistant	16,346	15,916	$135.82	498
Internal Medicine	9,857	8,909	$135.32	307
Emergency Medicine	3,446	3,288	$139.11	63
General Practice	1,259	1,163	$137.33	15
Pathology	1,255	1,210	$138.90	14
Nephrology	306	264	$139.78	6
Pediatric Medicine	146	137	$139.78	4
Hematology-Oncology	105	105	$139.78	1
Neurosurgery	102	54	$139.78	1
Cardiac Surgery	92	73	$139.78	1
Preventive Medicine	84	82	$138.62	2
Undefined Physician type	67	65	$137.69	1

87636 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
New York	50,607	$139.66	$139.78	177
California	39,972	$139.63	$139.78	101
Ohio	15,295	$139.63	$139.78	40
Texas	13,528	$136.58	$139.78	204
Tennessee	7,431	$136.23	$139.78	217
Kentucky	7,378	$137.02	$139.10	214
New Jersey	7,042	$139.71	$139.78	23
Illinois	5,391	$139.32	$139.78	107
Massachusetts	4,969	$139.49	$139.78	121
Washington	4,636	$136.63	$139.78	116
Mississippi	3,734	$137.67	$139.78	101
Maryland	3,541	$136.51	$138.23	121
South Carolina	3,386	$137.65	$139.78	92
North Carolina	3,312	$131.57	$132.82	85
Louisiana	2,985	$138.00	$139.78	63
Connecticut	2,845	$139.36	$139.78	77
Michigan	2,246	$136.81	$139.78	45
Florida	2,060	$137.13	$139.72	57
Pennsylvania	2,002	$138.54	$139.78	27
Arkansas	1,787	$138.64	$139.78	43
Arizona	1,596	$120.32	$139.78	25
Virginia	1,239	$136.24	$139.78	41
Colorado	1,140	$138.08	$139.78	45
Alabama	1,118	$135.78	$139.78	39
Missouri	1,079	$139.72	$139.78	16
Georgia	1,078	$135.46	$139.78	29
Oklahoma	713	$136.24	$139.78	14
Delaware	560	$138.25	$139.78	12
Iowa	526	$121.40	$139.78	11
Wisconsin	518	$138.59	$139.78	6
West Virginia	455	$135.34	$139.78	12
Minnesota	427	$138.39	$139.78	10
Montana	404	$139.43	$139.78	19
New Hampshire	353	$137.47	$139.78	11
New Mexico	343	$138.24	$139.78	9
Indiana	314	$138.00	$139.78	17
Hawaii	251	$138.19	$139.78	5
Rhode Island	238	$139.37	$139.78	3
District of Columbia	214	$139.78	$139.78	12
Utah	214	$112.53	$139.78	6
Wyoming	205	$130.73	$139.78	4
ZZ	187	$138.29	$139.78	1
Maine	174	$137.69	$139.78	4
Kansas	168	$137.54	$139.78	9
Oregon	159	$135.09	$139.78	5
Nevada	135	$135.93	$139.78	1
Idaho	76	$137.94	$139.78	3
South Dakota	62	$139.78	$139.78	4
Alaska	42	$139.78	$139.78	1
Nebraska	36	$139.78	$139.78	2

Related codes

87640Detection test by nucleic acid for staphylococcus aureus (bacteria)$34.35
87653Detection test by nucleic acid for strep (streptococcus$34.36
87635Amplifed dna or rna probe detection of severe acute respiratory syndro$50.11
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
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.