CPT 87804: Influenza Antigen Detection by Visual Immunoassay
Commercial payers pay $36 on average nationally for this procedure.
CPT code 87804 describes an infectious agent antigen detection test performed by an analyst using a direct optical (visual) immunoassay to detect influenza (flu) antigens in patient respiratory specimens, typically a throat or nasal swab or nasal washings; this is a point-of-care or clinical laboratory immunoassay service used to provide rapid diagnostic information at outpatient clinics, urgent care, emergency departments, and clinical laboratories.
For related coverage guidance, see recent payer policy updates: B-Hemolytic Streptococcus Testing, Human Immunodeficiency Virus (HIV) — Coverage Criteria for Testing and Resistance Assays, Hepatitis Testing (A, B, C, D) Coverage Criteria.
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National Reimbursement Benchmarks
Across national commercial payers, the BUCA average commercial rate for CPT 87804 sits at $35.50, providing a mid-market reference point. Blue Cross Blue Shield displays the highest dispersion between the 25th and 75th percentiles ($58.40 − $30.20 = $28.20), indicating greater variability in contracted rates. Aetna’s interquartile spread is $40.90 − $13.00 = $27.90, nearly as wide. Cigna and UnitedHealth Group show much tighter distributions: Cigna’s IQR is $20.60 − $8.50 = $12.10, and UnitedHealth Group’s is $16.60 − $14.00 = $2.60, the narrowest among listed payers.
In level comparisons, Blue Cross Blue Shield and Aetna drive most of the top-end variability, while UnitedHealth Group constrains rates more closely around its median. Cigna’s moderate spread suggests limited upside and downside from its central tendency. BUCA’s mean at $35.50 sits between Aetna and Blue Cross Blue Shield means, offering a useful benchmark for average commercial reimbursement on CPT 87804.