CPT 87804

Across 1,156,493 services billed by 19,908 providers to 595,481 beneficiaries, Medicare allowed an average of $16.08 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.

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.

• 87811Detection test by immunoassay$40.21
• 87801Detection test by nucleic acid for multiple organisms$68.67
• 87880Detection test by immunoassay$16.04
• 87807Detection test by immunoassay$12.74
• 87899Detection test by immunoassay$15.70
• 87800Detection test by nucleic acid for multiple organisms$42.68
• 87806Detection test by immunoassay$32.06

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.

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