How much does Medicare pay for CPT 87811?

Medicare allowed an average of $40.21 per service and paid $40.21 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $149.76, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 87811?

Detection test by immunoassay with direct visual observation for severe acute respiratory syndrome coronavirus 2 (covid-19). It was billed 783,946 times to 517,601 Medicare beneficiaries by 12,806 providers in 2024.

Does 87811 pay differently in an office than a hospital?

Yes. The allowed amount averaged $40.21 in an office setting and $40.55 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 87811 most?

Clinical Laboratory, with 232,480 services from 29 clinicians. Next are Nurse Practitioner, Physician Assistant, Family Practice.

CPT 87811

Detection test by immunoassay with direct visual observation for severe acute respiratory syndrome coronavirus 2 (covid-19)

$40.21Medicare-allowed amount per service, averaged across 783,946 services

Providers submitted

$149.76

Asking price, not received

Medicare allowed

$40.21

The fee schedule figure

Medicare paid

$40.21

Balance is patient coinsurance

Providers submitted an average of $149.76 for this code and Medicare allowed $40.21 — 3.7× 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 $40.21 (100%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $40.21
Hospital / facility: $40.55

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 783,880 services were billed in an office setting and 66 in a facility.

Services: 783,946
Beneficiaries: 517,601
Providers billing it: 12,806
Total allowed: $31,522,469

What Medicare pays for CPT 87811

Across 783,946 services billed by 12,806 providers to 517,601 beneficiaries, Medicare allowed an average of $40.21 per service. That is 1.5 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 87811

Specialty	Services	Beneficiaries	Avg allowed	Providers
Clinical Laboratory	232,480	49,107	$40.55	29
Nurse Practitioner	216,493	203,263	$40.12	5,709
Physician Assistant	116,239	111,816	$40.31	3,080
Family Practice	89,979	81,122	$39.48	2,273
Internal Medicine	41,781	35,967	$39.76	1,056
Pathology	38,405	4,024	$40.55	2
Emergency Medicine	22,024	20,420	$40.23	409
General Practice	14,839	4,669	$39.94	83
Nephrology	2,453	528	$40.54	5
Pulmonary Disease	2,282	1,017	$40.50	15
Hospitalist	875	796	$40.34	18
Pediatric Medicine	865	776	$40.33	22
General Surgery	802	775	$39.59	16
Geriatric Medicine	556	485	$40.03	15
Allergy/ Immunology	514	303	$40.34	10

87811 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
New York	211,234	$40.52	$40.55	741
Texas	78,253	$39.90	$40.55	953
California	76,481	$40.38	$40.48	537
Tennessee	34,828	$40.05	$40.55	883
Alabama	33,521	$39.05	$40.55	685
Florida	32,236	$40.36	$40.54	736
Louisiana	26,784	$40.11	$40.54	581
Georgia	22,986	$40.10	$40.54	747
New Jersey	22,929	$40.32	$40.55	472
Maryland	19,530	$40.33	$40.55	303
North Carolina	18,536	$40.26	$40.55	508
Pennsylvania	17,598	$40.32	$40.55	595
South Carolina	16,979	$40.01	$40.55	382
Oklahoma	16,341	$40.04	$40.55	339
Illinois	16,017	$40.33	$40.55	354
Arkansas	15,705	$40.22	$40.55	294
Mississippi	14,910	$39.94	$40.55	288
Virginia	12,947	$40.13	$40.55	360
Arizona	9,786	$40.10	$40.55	327
Ohio	8,563	$39.86	$40.55	318
Connecticut	8,525	$40.45	$40.55	247
Michigan	8,223	$40.21	$40.55	301
Indiana	8,034	$40.14	$40.55	258
Missouri	6,219	$40.27	$40.55	171
West Virginia	5,943	$38.97	$40.55	133
Massachusetts	5,920	$40.33	$40.55	172
Kentucky	5,603	$39.76	$40.55	219
Washington	4,834	$40.53	$40.55	55
Colorado	4,372	$40.31	$40.55	156
Kansas	3,376	$40.24	$40.54	99
Iowa	1,581	$40.26	$40.55	62
Nevada	1,556	$39.88	$40.55	52
Delaware	1,507	$40.28	$40.55	35
Oregon	1,389	$39.12	$40.55	59
Nebraska	1,367	$40.27	$40.55	62
Idaho	1,294	$39.95	$40.55	56
Rhode Island	1,100	$40.41	$40.52	31
New Hampshire	1,030	$40.04	$40.55	39
New Mexico	1,011	$40.39	$40.55	31
Utah	934	$40.29	$40.55	42
District of Columbia	809	$40.51	$40.55	21
Wisconsin	615	$40.23	$40.55	16
Hawaii	453	$40.14	$40.55	13
Minnesota	387	$40.45	$40.55	11
Alaska	351	$39.97	$40.55	13
Wyoming	323	$38.66	$40.55	12
Montana	281	$40.43	$40.55	7
Guam	206	$39.63	$40.55	8
South Dakota	118	$40.29	$40.55	4
AP	115	$40.55	$40.55	3
Puerto Rico	91	$40.55	$40.55	4
North Dakota	90	$40.55	$40.55	4
Maine	65	$39.30	$40.55	4
Vermont	60	$40.55	$40.55	3

Related codes

87804Detection test by immunoassay$16.08
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

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.