How much does Medicare pay for CPT 87640?

Medicare allowed an average of $34.35 per service and paid $34.35 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $58.48, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 87640?

Detection test by nucleic acid for staphylococcus aureus (bacteria), amplified probe technique. It was billed 872,817 times to 613,073 Medicare beneficiaries by 1,107 providers in 2024.

Does 87640 pay differently in an office than a hospital?

Yes. The allowed amount averaged $34.35 in an office setting and $34.39 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 87640 most?

Clinical Laboratory, with 753,929 services from 420 clinicians. Next are Urology, Pathology, Nurse Practitioner.

CPT 87640

Detection test by nucleic acid for staphylococcus aureus (bacteria), amplified probe technique

$34.35Medicare-allowed amount per service, averaged across 872,817 services

Providers submitted

$58.48

Asking price, not received

Medicare allowed

$34.35

The fee schedule figure

Medicare paid

$34.35

Balance is patient coinsurance

Providers submitted an average of $58.48 for this code and Medicare allowed $34.35 — 1.7× 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 $34.35 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $34.35
Hospital / facility: $34.39

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 872,770 services were billed in an office setting and 47 in a facility.

Services: 872,817
Beneficiaries: 613,073
Providers billing it: 1,107
Total allowed: $29,981,264

What Medicare pays for CPT 87640

Across 872,817 services billed by 1,107 providers to 613,073 beneficiaries, Medicare allowed an average of $34.35 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 87640

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	753,929	529,272	$34.36	420
Urology	58,054	37,646	$34.29	373
Pathology	34,444	25,597	$34.32	39
Nurse Practitioner	9,365	7,762	$34.23	103
Podiatry	5,771	4,196	$34.31	56
Physician Assistant	5,240	4,145	$34.33	61
Internal Medicine	2,752	2,033	$34.38	14
Obstetrics & Gynecology	1,190	726	$34.36	11
Family Practice	819	686	$34.27	11
Undersea and Hyperbaric Medicine	412	313	$34.09	1
Emergency Medicine	301	237	$34.39	4
Neurosurgery	205	195	$33.81	5
Interventional Pain Management	148	98	$34.39	1
Orthopedic Surgery	72	71	$34.39	4
General Surgery	43	34	$34.39	1

87640 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	312,083	$34.37	$34.39	280
California	133,564	$34.39	$34.39	79
Florida	82,886	$34.32	$34.39	94
Pennsylvania	48,947	$34.38	$34.39	29
Illinois	30,111	$34.35	$34.39	44
Maryland	27,546	$34.36	$34.39	47
Arizona	26,628	$34.38	$34.39	7
Arkansas	26,141	$34.29	$34.36	32
New York	23,116	$34.34	$34.39	38
New Jersey	22,572	$34.34	$34.39	37
Colorado	21,818	$34.38	$34.39	47
Louisiana	20,605	$34.07	$34.39	23
Mississippi	16,549	$34.31	$34.39	58
Oklahoma	16,281	$34.32	$34.39	39
Indiana	15,030	$34.39	$34.39	6
North Carolina	8,820	$34.39	$34.39	3
Massachusetts	5,741	$34.36	$34.39	44
Virginia	5,137	$34.36	$34.39	18
Missouri	4,382	$34.37	$34.39	9
Delaware	4,308	$34.34	$34.39	22
Tennessee	3,376	$34.33	$34.39	20
Utah	3,255	$34.39	$34.39	6
Michigan	2,402	$34.28	$34.39	11
Wisconsin	1,993	$33.56	$34.39	3
Alabama	1,371	$33.14	$34.39	8
Ohio	1,270	$34.39	$34.39	2
Connecticut	1,058	$34.39	$34.39	4
Georgia	976	$34.36	$34.39	4
Nebraska	670	$34.31	$34.39	11
New Mexico	581	$34.12	$34.39	9
Iowa	502	$34.39	$34.39	8
New Hampshire	466	$34.32	$34.39	14
Kansas	464	$34.34	$34.39	5
Wyoming	459	$34.34	$34.39	8
Oregon	389	$34.33	$34.39	4
Washington	321	$34.21	$34.39	11
Rhode Island	247	$34.13	$34.39	9
Minnesota	198	$34.39	$34.39	1
Nevada	168	$34.39	$34.39	3
South Carolina	107	$31.98	$34.39	2
Kentucky	85	$34.39	$34.39	2
West Virginia	50	$34.39	$34.39	1
Maine	46	$34.39	$34.39	1
Idaho	43	$34.39	$34.39	2
District of Columbia	43	$34.39	$34.39	1
North Dakota	12	$34.39	$34.39	1

Related codes

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
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.