CPT 87798: infectious agent test by nucleic acid (PCR). What Medicare pays and what to ask
PCR tests can be billed one organism at a time. Here is what 87798 means and how the Medicare rate per unit works.
This rate is for one billing unit. Multiply it by the number of units on your bill to compare with the amount charged.
What this code means
CPT 87798 is a lab test that detects the genetic material of an infectious organism, usually by PCR, when no more specific code exists.
It is billed once for each organism tested, so a panel can produce several units.
Why the bill can be much higher than the Medicare rate
The rate is per unit, so a panel of several organisms multiplies the charge.
A test panel can be billed under one code or several, so the list of organisms is worth asking for.
| If a line is billed at | It would be |
|---|---|
| 5x the Medicare rate | $175.45 per organism tested |
| 10x the Medicare rate | $350.90 per organism tested |
| 20x the Medicare rate | $701.80 per organism tested |
The Medicare rate is a published benchmark, not a legal ceiling on what a provider may charge. Our free scan flags a line as worth a closer look when it is billed at more than 10 times the Medicare rate.
Questions worth asking before you pay
- How many organisms were tested, and how many units are billed?
- Is there a more specific code for this test?
- Was the same test repeated on the same day?
Check every line against the official Medicare rates in about a minute. The scan is free.
Related codes
Source: Medicare Clinical Laboratory Fee Schedule (CMS, 2026), national payment limit. Last updated October 2026. This page is general information, not legal or medical advice. Rates change each year and a hospital bill can include charges that the benchmark does not cover.