How much does Medicare pay for CPT 87653?

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 $58.42, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 87653?

Detection test by nucleic acid for strep (streptococcus, group b), amplified probe technique. It was billed 804,203 times to 569,940 Medicare beneficiaries by 974 providers in 2024.

Does 87653 pay differently in an office than a hospital?

Yes. The allowed amount averaged $34.36 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 87653 most?

Clinical Laboratory, with 694,582 services from 387 clinicians. Next are Urology, Pathology, Nurse Practitioner.

CPT 87653

Detection test by nucleic acid for strep (streptococcus, group b), amplified probe technique

$34.36Medicare-allowed amount per service, averaged across 804,203 services

Providers submitted

$58.42

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 $58.42 for this code and Medicare allowed $34.36 — 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 $34.36 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $34.36
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. 804,156 services were billed in an office setting and 47 in a facility.

Services: 804,203
Beneficiaries: 569,940
Providers billing it: 974
Total allowed: $27,632,415

What Medicare pays for CPT 87653

Across 804,203 services billed by 974 providers to 569,940 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 87653

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	694,582	492,696	$34.37	387
Urology	54,592	35,316	$34.29	337
Pathology	32,244	24,265	$34.33	31
Nurse Practitioner	8,259	6,821	$34.23	92
Physician Assistant	5,255	4,150	$34.33	59
Podiatry	3,508	2,417	$34.37	24
Internal Medicine	2,499	1,863	$34.37	15
Family Practice	1,186	951	$34.36	10
Obstetrics & Gynecology	1,121	677	$34.33	12
Undersea and Hyperbaric Medicine	419	319	$33.82	1
Hematology-Oncology	398	341	$34.07	1
Emergency Medicine	108	99	$34.10	4
General Practice	32	25	$33.43	1

87653 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	258,532	$34.36	$34.39	240
California	89,336	$34.39	$34.39	73
Florida	86,189	$34.37	$34.39	92
Pennsylvania	76,699	$34.39	$34.39	17
Arizona	30,606	$34.38	$34.39	6
Maryland	27,051	$34.36	$34.39	46
Illinois	25,578	$34.34	$34.39	39
New Jersey	25,526	$34.35	$34.39	41
Arkansas	24,693	$34.32	$34.39	30
Colorado	22,492	$34.38	$34.39	48
New York	22,296	$34.34	$34.39	38
Mississippi	20,600	$34.33	$34.39	44
Oklahoma	19,023	$34.33	$34.39	39
Indiana	14,045	$34.39	$34.39	4
Louisiana	11,872	$34.37	$34.39	22
Virginia	10,013	$34.39	$34.39	16
North Carolina	7,807	$34.39	$34.39	1
Delaware	4,316	$34.34	$34.39	22
Missouri	4,283	$34.35	$34.39	10
Massachusetts	3,370	$34.36	$34.39	28
Tennessee	3,282	$34.31	$34.39	16
Michigan	3,240	$33.91	$34.39	10
Utah	3,034	$34.39	$34.39	4
Kansas	2,837	$34.36	$34.39	4
Ohio	1,310	$34.39	$34.39	8
Georgia	966	$34.39	$34.39	2
Connecticut	868	$34.39	$34.39	5
Wyoming	717	$34.11	$34.39	8
Nebraska	670	$34.31	$34.39	11
Iowa	489	$34.39	$34.39	7
New Hampshire	474	$34.32	$34.39	14
Puerto Rico	444	$34.39	$34.39	1
New Mexico	439	$33.96	$34.39	6
Nevada	423	$34.39	$34.39	4
Minnesota	198	$34.39	$34.39	1
Washington	121	$34.39	$34.39	5
South Carolina	82	$34.39	$34.39	1
Alabama	79	$34.39	$34.39	3
Kentucky	78	$34.39	$34.39	3
Maine	47	$34.39	$34.39	1
Idaho	43	$34.39	$34.39	2
Oregon	35	$34.39	$34.39	2

Related codes

87640Detection test by nucleic acid for staphylococcus aureus (bacteria)$34.35
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.