How much does Medicare pay for CPT 87799?

Medicare allowed an average of $41.86 per service and paid $41.86 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $291.39, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 87799?

Detection test by nucleic acid for organism, quantification. It was billed 202,781 times to 65,464 Medicare beneficiaries by 218 providers in 2024.

Which specialty bills 87799 most?

Clinical Laboratory, with 178,452 services from 126 clinicians. Next are Pathology, Urology, Nurse Practitioner.

CPT 87799

Detection test by nucleic acid for organism, quantification

$41.86Medicare-allowed amount per service, averaged across 202,781 services

Providers submitted

$291.39

Asking price, not received

Medicare allowed

$41.86

The fee schedule figure

Medicare paid

$41.86

Balance is patient coinsurance

Providers submitted an average of $291.39 for this code and Medicare allowed $41.86 — 7.0× 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 $41.86 (100%); the rest is the patient’s coinsurance and deductible.

Services: 202,781
Beneficiaries: 65,464
Providers billing it: 218
Total allowed: $8,488,413

What Medicare pays for CPT 87799

Across 202,781 services billed by 218 providers to 65,464 beneficiaries, Medicare allowed an average of $41.86 per service. That is 3.1 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 87799

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	178,452	55,250	$41.86	126
Pathology	13,353	4,160	$41.98	11
Urology	6,874	4,383	$41.85	46
Nurse Practitioner	1,653	503	$41.88	9
Physician Assistant	1,162	674	$41.98	8
Podiatry	561	208	$41.48	8
Family Practice	424	123	$40.89	7
Obstetrics & Gynecology	150	127	$41.74	1
Hematology-Oncology	84	15	$41.98	1
Internal Medicine	68	21	$39.17	1

87799 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
Maryland	33,915	$41.96	$41.98	24
California	25,659	$41.96	$41.98	20
Texas	25,048	$41.90	$41.98	18
New Jersey	20,405	$41.95	$41.98	6
Pennsylvania	16,616	$41.95	$41.98	7
North Carolina	10,767	$41.91	$41.98	2
Florida	9,763	$41.81	$41.98	8
Georgia	6,592	$41.98	$41.98	2
Arizona	5,806	$41.88	$41.98	3
Illinois	4,404	$41.98	$41.98	4
Arkansas	4,115	$41.92	$41.98	20
Minnesota	3,807	$41.55	$41.98	13
Massachusetts	3,644	$41.91	$41.98	3
New York	3,477	$41.85	$41.98	4
Kansas	3,397	$41.85	$41.97	4
Ohio	2,762	$41.90	$41.98	4
Alabama	2,546	$41.97	$41.98	1
Tennessee	2,419	$41.83	$41.98	15
Wisconsin	2,374	$38.48	$41.98	3
Louisiana	2,141	$41.98	$41.98	2
Utah	2,074	$41.91	$41.98	8
Washington	1,556	$41.82	$41.98	5
Virginia	1,462	$41.55	$41.98	3
Mississippi	1,420	$41.85	$41.98	6
Oklahoma	1,248	$41.61	$41.98	8
Hawaii	1,237	$41.35	$41.98	2
Nevada	885	$41.98	$41.98	1
Oregon	865	$41.34	$41.98	5
Colorado	558	$41.28	$41.98	3
Michigan	449	$41.98	$41.98	3
Iowa	429	$41.32	$41.98	2
New Mexico	372	$41.68	$41.98	2
Maine	304	$41.11	$41.98	2
South Dakota	150	$41.79	$41.98	2
Kentucky	67	$41.40	$41.98	2
Indiana	48	$41.98	$41.98	1

Related codes

87798Detection test by nucleic acid for organism$34.36

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.