CPT 87635
COVID-19 PCR test
A laboratory PCR test for SARS-CoV-2. Hospitals often run it on admission and before procedures. Combined tests for COVID, flu and RSV use different codes (87636, 87637).
Billed to Medicare
$186
What providers submitted, on average, for this code in a hospital setting.
Medicare accepted
$50
What Medicare treated as payable. Not a commercial rate or a cash price.
The gap
3.7x
How many times the accepted amount the billed figure was.
National averages from the Centers for Medicare & Medicaid Services, 2024 data, retrieved 2026-09-14. Medicare fee-for-service, physician and practitioner claims only. The hospital's own charge for the same code is separate and is usually higher. Based on 415 services.
Among the 10 lab tests codes on this site with CMS figures, this gap ranks 6 of 10 (median 3.7x). The widest is Urinalysis, automated with microscopy at 5.5x.
Where this line goes wrong
Coverage changed
During the public health emergency this test was free to patients. Since May 2023 it is subject to normal cost sharing, so a charge is no longer automatically an error. Whether it was necessary is the question.
Combined panel plus single test
A combined COVID/flu panel (87636) billed alongside a standalone COVID PCR (87635) on the same sample is a duplicate.
Check it, then ask
- 1
Ask for the itemized bill and the lab results and match every billed test to a result.
- 2
Check for a panel billed alongside one of its own components, or two overlapping panels on the same draw.
- 3
Count the blood draw (36415) lines; one per visit is the norm.
- 4
If self-pay, ask for the hospital's cash price for each test, or compare with an independent lab's published price.
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Codes that travel with this one
People also ask
Why did I have to pay for a COVID test at the hospital?
Because the federal rule that made them free ended in 2023. A diagnostic test ordered by the hospital is now covered like any other lab test, subject to your deductible and coinsurance.
Sources
This page explains a billing code in general terms. It is not a coding, legal or medical opinion about your bill, and the code descriptions are mediloop's own plain-English summaries, not the official CPT descriptors, which are owned by the American Medical Association. Whether a charge was correct depends on the record of your visit and your payer's rules.