CPT 87086: Urine Culture with Quantitative Colony Count
Commercial payers pay $25 on average nationally for this procedure.
CPT code 87086 describes a urine culture with quantitative colony count where a laboratory analyst or microbiologist cultures a submitted urine specimen (often a clean-catch or catheterized collection) and reports the quantitative colony count if growth is present; this is a microbiology culture service typically performed in a clinical laboratory or hospital laboratory setting for evaluation of urinary tract infections and related bacteriologic assessments.
For related coverage guidance, see recent payer policy updates: Long-Acting Injectable Antiretroviral Agents for HIV, B-Hemolytic Streptococcus Testing, Human Immunodeficiency Virus (HIV) — Coverage Criteria for Testing and Resistance Assays.
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National Reimbursement Benchmarks
National commercial pricing for CPT 87086 centers around a BUCA average of $24.7, with notable variation by carrier. Blue Cross Blue Shield posts the highest dispersion window (P75 $46.4 minus P25 $25.9 = $20.5), indicating a wide spread of commercial contract rates. Aetna and Cigna show moderate spreads (Aetna P75 $12.1 minus P25 $6.0 = $6.1; Cigna P75 $11.9 minus P25 $5.0 = $6.9), while UnitedHealth Group exhibits the tightest interquartile range (P75 $8.1 minus P25 $3.6 = $4.5), suggesting more consistency among its commercial reimbursements.
Examining median and mean relationships highlights further differences: Blue Cross Blue Shield’s mean of $36.3 sits above its median $35.1, pointing to higher-rate outliers, while UnitedHealth Group’s mean $7.1 is near its median $4.8, consistent with a compact distribution. Aetna (mean $11.5, median $7.3) and Cigna (mean $9.1, median $7.3) both have means above medians, implying some upward skew. BUCA’s average of $24.7 provides an industry-level commercial benchmark between the lower-consistency payers and Blue Cross Blue Shield’s wider range.