COVID-19 antigen test (CPT 87426): what Medicare pays
On a hospital bill, CPT 87426 is the code for: Detection test by immunoassay technique for severe acute respiratory syndrome coronavirus. Here is what Medicare pays for it, what is billed on average, and how to question the line on your bill.
CPT 87426 at a glance
| Medicare average allowed amount | $34.30 |
|---|---|
| Average amount billed to Medicare | $97.92 |
| Billed vs. allowed | 2.9 times |
| Services in the data | 624,247 |
| Setting and year | Office or clinic, national average, 2024 |
What this code is
This is a laboratory test done on a sample, most often blood.
Why your hospital bill can show more
Medicare pays a national amount for each code. Hospitals set their own list prices, called the chargemaster, so a hospital bill can show a much higher amount for the same code. In a hospital or an emergency room, a separate facility charge is often added. Medicare's amount is not a price the hospital must accept, but it is a fair reference to negotiate.
Common billing problems with CPT 87426
Billed twice on the same day
The same code, on the same day and at the same price, can appear twice. Sometimes it is real (a second sample, the other side, mother and baby). Ask for the time and the reason of each one, and ask them to remove the extra charge if it was done once.
No code on the line
If your bill shows a total without codes, ask for a fully itemized bill. Without codes, nobody can check the charges.
How to question this charge
- Ask the hospital for a fully itemized bill, with the code, date, quantity and price of every line.
- Compare the line with the Medicare amount above.
- Ask in writing for a fair price, the lowest amount they will accept, and any discount for paying in full or for patients without insurance.
- Ask for the hospital's financial assistance policy.
BillCheck reads a photo of your bill on your phone, compares every line and writes the letter. Check my bill.
Related codes
- CPT 87635: COVID-19 PCR test
- CPT 84484: Troponin test
- CPT 83690: Lipase test
- CPT 83605: Lactic acid test
- CPT 83735: Magnesium test
- CPT 85610: PT/INR clotting test
Frequently asked questions
How much does CPT 87426 cost?
It depends on where it is done. In 2024, Medicare's average allowed amount for CPT 87426 in an office setting was $34.30, and providers billed Medicare $97.92 on average. Hospitals can bill more. If you have no insurance, ask for the self-pay price before you pay.
Can I be billed twice for CPT 87426 on the same day?
Only if it was really done twice. Ask for the time and the reason of each line. If it was done once, ask them to remove the extra charge.
What is the difference between CPT 87426 and CPT 87635?
CPT 87426 is COVID-19 antigen test. CPT 87635 is COVID-19 PCR test. Medicare's average allowed amounts were $34.30 and $50.06 in 2024.
How do I question this charge?
Ask for an itemized bill, compare the line with the Medicare amount, then ask in writing for a fair price and for financial assistance. BillCheck writes the letter for you.