CPT code 87040: Blood culture, bacterial culture2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Bacterial blood culture detects bloodstream bacteria and supports isolation and presumptive identification when bacteremia or sepsis is suspected.
Medicare pays $10.32 for 87040 under the 2026 Clinical Laboratory Fee Schedule: one national amount, the same in every state and setting.
Medicare lab fee · CLFS 2026 Q4
National CLFS amount
$10.32
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2020
- Unchanged
- CMS updates
- Quarterly
Medicare pays the lesser of the lab’s charge and this amount. Patients usually owe no Part B deductible or coinsurance for covered clinical lab tests.
On this page 8 sections
What 87040 covers
This laboratory service cultures a blood specimen for bacterial growth and recovers isolates for presumptive identification. Clinicians commonly order it when bloodstream infection is suspected, including during evaluation for possible bacteremia or sepsis. Hospital and independent laboratories perform the culture on blood collected for microbiology testing. Anaerobic culture is included when appropriate. The recovered organism can help clinicians evaluate a bloodstream infection and guide further care.
Report 87040 for bacterial blood culture, including isolation and presumptive identification; anaerobic culture is included when appropriate. Medicare pays the test only through the CLFS. The 2026 national CLFS amount is $10.32, unchanged since 2020, and the same amount applies in every locality, with no geographic or office-versus-facility adjustment. The test is excluded from the physician fee schedule.
This summary was written with AI assistance from CMS Clinical Laboratory Fee Schedule data. Amounts on this page come directly from CMS files.
How Medicare pays 87040
Clinical lab tests aren’t priced like physician services. They’re paid from their own fee schedule, with its own rules. See the whole lab fee schedule.
One national amount
CMS sets a single Clinical Laboratory Fee Schedule amount for 87040. There’s no geographic (GPCI) adjustment, so it pays the same in every state and payment locality.
No office or facility rate
Lab tests aren’t built from relative value units, so there’s no office and facility split: the place of service doesn’t change the CLFS amount.
Updated every quarter
CMS republishes the CLFS each quarter. New tests, often proprietary laboratory analyses (PLA codes), join during the year; existing amounts are updated each January.
Excluded from the physician fee schedule
The physician fee schedule lists 87040 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87040 on the lab fee schedule since 2020
87040 · CLFS 2026 Q4 (current)
$10.32
Unchanged since Jan 1, 2020
27 quarterly CLFS releases on file, first CLFS 2020 Q1. A code missing from a quarter wasn’t on that release.
87040 compared with similar tests
- 87045Stool cultureAerobic, Salmonella and Shigella$9.44
- 87045 is for aerobic bacterial culture of feces; 87040 is for bacterial culture of blood.
- 87070Aerobic cultureNon-urine, blood, or stool$8.62
- 87070 applies to aerobic bacterial culture of a specimen other than blood. Select 87040 when the cultured specimen is blood.
- 87075Anaerobic cultureNonblood source$9.47
- 87075 is for bacterial culture of a nonblood specimen. A blood specimen is reported with 87040.
- 87086Urine cultureQuantitative colony count$8.07
- 87086 is for urine culture and colony count; 87040 is for bacterial culture of blood.
87040 billing questions
When should 87040 be used instead of 87070?
Use 87040 for bacterial culture of blood. Code 87070 is for aerobic bacterial culture of another specimen.
Does 87040 include presumptive identification?
Yes. The service includes isolation and presumptive identification of bacterial isolates.
Is anaerobic culture included?
Anaerobic culture is included when appropriate as part of the blood-culture service.
How does Medicare pay 87040?
Medicare pays the test under the CLFS at one national amount, with no locality or office-versus-facility adjustment. The test is excluded from the physician fee schedule.
How does 87040 differ from a urine culture?
87040 is for bacterial culture of blood. Code 87086 is for urine culture and colony count.
Where this amount comes from
FeeBase reads lab amounts directly from the CMS Clinical Laboratory Fee Schedule file for the quarter: one row per code, with its payment indicator and national amount. Contractor-priced tests are labeled, never given a made-up amount. Amounts are Medicare payment limits, not a patient’s bill or a commercial rate.
CMS CLFS 2026 Q4 · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file line behind this amount
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