| Category | Amount |
|---|---|
| Medicare Allowed Rate What Medicare approves for this service | $16.55 |
| Typical Billed Amount What providers commonly charge | $25 – $120 |
| Potential Markup How much more you might pay vs. Medicare rate | 625% above Medicare |
What CPT Code 87804 Means and When It's Used
CPT code 87804 represents a rapid influenza test that uses direct optical detection to identify flu viruses in your system. This is the quick test your doctor performs during flu season when you come in with symptoms like fever, body aches, and fatigue.
The test involves taking a nasal swab and getting results within 15-20 minutes, right there in the office. Your doctor uses this immediate result to decide whether to prescribe antiviral medications or recommend other treatments. It's different from more complex lab tests that might be sent out and take days to process.
You'll typically see this code on your bill when you visit during flu season with flu-like symptoms, or sometimes as part of routine screening before medical procedures during peak flu months.
How Billing Works for Your Rapid Flu Test
When you see CPT code 87804 on your medical bill, you're being charged for the rapid flu test performed during your visit. Medicare reimburses this test at $16.55, but you'll likely see charges ranging from $25 to $120 depending on your healthcare provider and location.
This test is usually covered by most insurance plans, especially during flu season, but you may still owe a copay or need to meet your deductible first. The charge should appear as a separate line item on your bill, distinct from your office visit fee.
If you have a high-deductible health plan, you might pay the full amount out-of-pocket until you meet your deductible. With traditional insurance, you'll typically pay a small copay or coinsurance percentage after your insurance processes the claim.
How to Verify Your Flu Test Charges Are Correct
To check if your CPT 87804 charge is reasonable, first confirm that you actually received a rapid flu test during your visit. Look for charges between $25-$120, as anything significantly higher might warrant a question to your provider's billing department.
Compare your bill to your insurance explanation of benefits (EOB) to ensure the amounts match. If you see a charge much higher than $120, or if you're charged for this test but don't remember getting a nasal swab, contact your healthcare provider's billing office for clarification.
If you believe you were overcharged, gather your medical records from the visit and call the billing department. Ask them to explain the charge and provide documentation that the test was performed. Most billing errors can be resolved with a simple phone call, and many providers offer payment plans if the cost is a financial hardship.