How much does Medicare pay for CPT 87798?

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 $63.39, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 87798?

Detection test by nucleic acid for organism, amplified probe technique. It was billed 12,712,408 times to 863,775 Medicare beneficiaries by 1,416 providers in 2024.

Does 87798 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 87798 most?

Clinical Laboratory, with 11,272,576 services from 588 clinicians. Next are Urology, Pathology, Podiatry.

CPT 87798

Detection test by nucleic acid for organism, amplified probe technique

$34.36Medicare-allowed amount per service, averaged across 12,712,408 services

Providers submitted

$63.39

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 $63.39 for this code and Medicare allowed $34.36 — 1.8× 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. 12,711,815 services were billed in an office setting and 593 in a facility.

Services: 12,712,408
Beneficiaries: 863,775
Providers billing it: 1,416
Total allowed: $436,798,339

What Medicare pays for CPT 87798

Across 12,712,408 services billed by 1,416 providers to 863,775 beneficiaries, Medicare allowed an average of $34.36 per service. That is 14.7 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 87798

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	11,272,576	757,998	$34.37	588
Urology	601,406	38,436	$34.31	396
Pathology	469,801	36,654	$34.12	52
Podiatry	130,846	9,102	$34.34	87
Nurse Practitioner	104,807	8,394	$34.24	117
Physician Assistant	54,599	4,375	$34.31	70
Internal Medicine	29,594	3,546	$33.36	36
Family Practice	21,133	2,981	$34.29	34
Obstetrics & Gynecology	17,154	1,184	$34.32	18
Hematology-Oncology	3,832	352	$34.25	2
Interventional Pain Management	1,911	97	$34.39	1
Emergency Medicine	1,331	203	$34.07	6
General Practice	949	203	$34.07	3
Dermatology	861	81	$34.39	2
Cardiology	624	42	$34.39	1

87798 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	4,045,644	$34.36	$34.38	312
California	2,092,614	$34.38	$34.39	127
Pennsylvania	1,065,281	$34.38	$34.39	39
Florida	987,267	$34.34	$34.39	126
New Jersey	660,961	$34.36	$34.39	51
Arizona	431,779	$34.38	$34.39	10
Illinois	419,065	$34.34	$34.38	54
Maryland	360,308	$34.36	$34.39	60
Colorado	353,467	$34.38	$34.39	54
New York	336,121	$34.34	$34.39	52
Mississippi	290,697	$34.30	$34.39	66
Louisiana	268,681	$34.38	$34.39	33
Oklahoma	237,614	$34.33	$34.38	43
Arkansas	221,684	$34.36	$34.39	30
Indiana	197,696	$34.39	$34.39	8
Virginia	133,362	$34.36	$34.39	24
North Carolina	114,802	$34.38	$34.39	7
Massachusetts	89,339	$34.36	$34.39	48
Missouri	82,850	$33.16	$34.39	27
Delaware	53,839	$34.34	$34.39	22
Michigan	45,408	$34.29	$34.38	16
Kansas	39,527	$34.38	$34.39	21
Utah	37,574	$34.38	$34.38	6
Tennessee	24,914	$34.39	$34.39	16
Georgia	18,027	$34.38	$34.39	8
Ohio	16,407	$34.39	$34.39	6
Connecticut	14,525	$34.39	$34.39	7
New Mexico	9,856	$34.14	$34.39	11
Nebraska	9,083	$34.23	$34.35	17
Wyoming	6,888	$34.15	$34.39	8
Iowa	6,557	$34.33	$34.39	10
New Hampshire	6,162	$34.32	$34.39	14
Puerto Rico	5,888	$34.32	$34.32	2
Nevada	5,575	$34.39	$34.39	6
Minnesota	4,780	$33.88	$34.39	7
Rhode Island	3,532	$34.14	$34.39	10
Washington	3,493	$34.10	$34.27	16
Wisconsin	2,073	$34.20	$34.39	6
Alabama	2,031	$33.86	$34.39	8
Oregon	1,851	$33.51	$34.39	9
District of Columbia	1,446	$34.39	$34.39	2
South Carolina	1,427	$34.39	$34.39	1
Kentucky	1,202	$34.27	$34.39	5
Idaho	525	$34.39	$34.39	3
Hawaii	266	$34.39	$34.39	2
Maine	109	$34.39	$34.39	2
North Dakota	78	$34.39	$34.39	1
South Dakota	78	$34.33	$34.39	2
West Virginia	55	$34.39	$34.39	1

Related codes

87799Detection test by nucleic acid for organism$41.86

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.