CPT 87207Laboratory

Smear special stain

CPT code 87207 covers the laboratory procedure of applying special stains to a smear sample to help identify microorganisms like bacteria, fungi, or parasites under a microscope. This is a common diagnostic test used to detect infections that standard staining methods might miss.

Showing rates for

National Average

Base Medicare rate

$17.14

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.37

PE RVU (NF)

0.15

MP RVU

0.01

Total RVU

0.53

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

Loading bundling edits…

Billing tips

Document the specific type of special stain performed (acid-fast, GMS, PAS, trichrome, etc.) in the procedure description and medical record
Impact: Reduces denials for lack of specificity; payers often deny claims lacking stain type documentation, resulting in $17.14 loss per test
Bill 87207 separately for each type of special stain performed, not per slide or per field examined
Impact: Each distinct stain method qualifies as a separate billable service with modifier 59/XS; can increase revenue by $17.14 per additional stain type when medically necessary
Verify that special stain is not bundled into the primary culture or identification code before billing separately
Impact: Medicare and commercial payers frequently bundle special stains with culture codes 87070-87077; unbundling can trigger audits and recoupment
Ensure medical necessity is clearly documented with specific clinical indication (suspected TB, fungal infection, etc.) in the ordering physician's notes
Impact: Lack of medical necessity is the #1 denial reason; proper documentation can prevent 30-40% of denials
For acid-fast bacilli (AFB) stains, consider using 87206 instead if only performing a basic AFB smear without special modifications
Impact: Code selection accuracy prevents downcoding; 87206 has similar reimbursement but different documentation requirements
When billing multiple units on the same date of service, attach detailed notes explaining why multiple special stains were medically necessary
Impact: Proactive documentation reduces claim review time and prevents automatic denials for units greater than one; saves appeal costs of $50-150 per claim

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 87207?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the Medicare reimbursement rate for CPT code 87207 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 87207 is $17.14 for both facility and non-facility settings. This is based on a total RVU of 0.53 (Work RVU 0.37, PE RVU 0.15, MP RVU 0.01) multiplied by the 2025 conversion factor of 32.3465.

Can CPT 87207 be billed multiple times on the same date of service?

Yes, CPT 87207 can be billed multiple times on the same date when different types of special stains are performed (e.g., acid-fast stain and fungal stain). Use modifier 59 or XS to indicate distinct procedural services. Each stain type must be medically necessary and documented separately. Billing multiple units requires clear documentation of why each special stain was needed.

What is the difference between CPT 87205, 87206, and 87207?

CPT 87205 covers smear primary source with Gram or Giemsa stain. CPT 87206 is for fluorescent or acid-fast stain smears. CPT 87207 encompasses other special stains not covered by 87205 or 87206, including PAS, GMS, trichrome, and modified acid-fast stains. Code selection depends on the specific staining technique performed.

Is prior authorization required for CPT 87207?

Prior authorization requirements vary by payer. Medicare typically does not require prior authorization for 87207, but some Medicare Advantage plans and commercial payers may require it for special stains, especially when ordered in high frequency or with certain diagnosis codes. Always verify payer-specific policies before performing the test.

What diagnosis codes support medical necessity for CPT 87207?

Common supporting diagnosis codes include A15-A19 (tuberculosis), A31 (mycobacterial infections), B35-B49 (mycoses/fungal infections), A07 (protozoal intestinal diseases), R50.9 (fever unspecified), and Z11.1 (screening for respiratory tuberculosis). The diagnosis must indicate suspected infection requiring special stain identification beyond routine methods.

Can 87207 be billed with culture codes on the same specimen?

Generally yes, but verify payer bundling policies. While 87207 is not automatically bundled with culture codes in NCCI edits, many payers consider special stains incidental to culture and identification procedures. Medical necessity documentation must clearly show the special stain provided distinct diagnostic information not obtained from culture alone. Consider using modifier 59/XS when appropriate.

What CLIA certification level is required to perform CPT 87207?

CPT 87207 requires CLIA certification for high-complexity testing. The laboratory must have a CLIA certificate of compliance or accreditation and must employ qualified personnel (medical technologists or clinical laboratory scientists) under appropriate supervision by a pathologist or qualified laboratory director. Moderate or waived CLIA certification is insufficient for this code.