Blood culture to grow and detect bacteria in a blood sample, including presumptive identification of any organisms that grow, billed per culture set drawn.
- Medicare
- $0.00
- Work RVU
- 0
- Global, days
- Region
- General
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Fever, vital signs, and systemic signs of infection
- Number of culture sets and draw sites
- Time of draw relative to the first antibiotic dose
- Suspected source: joint, bone, spine, or surgical site
- Diagnosis code for suspected infection or sepsis
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
87040 is the blood culture for bacteria, with isolation and presumptive identification of what grows (anaerobic culture is included when done). It is billed per culture, so two sets drawn from two sites are two units.
Orthopedic teams order blood cultures when infection is on the table: suspected septic arthritis, acute osteomyelitis, a spinal epidural abscess, or a red, hot total joint weeks after surgery. Cultures drawn before antibiotics start give the best yield, and the note should say when the first dose went in.
The lab bills 87040 under the Clinical Laboratory Fee Schedule. The usual mistakes are units and add-ons. Two sets should show two units, usually with 59 or XS on the second line to show a separate draw. Definitive identification of an isolate (87077) and susceptibility testing (87184 or 87186) are billed separately when the lab does them. If the culture is negative after five days, nothing extra is added. Linking the claim to a fever, sepsis, or infection diagnosis rather than joint pain prevents most medical necessity edits.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 0 |
| Practice expense RVU | 0 |
| Malpractice RVU | 0 |
| Total RVU | 0 |
| Medicare national rate | $0.00 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $0.00 |
Common denial reasons
The recurring reasons claims for CPT 87040 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Second set billed without modifier and rejected as a duplicate
- Diagnosis code is joint pain rather than suspected infection
- Definitive identification billed without a positive culture on the report
- Billed by the ordering practice instead of the lab
- Units exceed medically unlikely edit without supporting documentation
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01How many units of 87040 for two sets of blood cultures?
02Is organism identification included in 87040?
03When should blood cultures be ordered for suspected septic arthritis?
Sources & references
Editorial content was developed using the following public sources.
- 01CMS Physician Fee Schedule 2026
- 02CMS Clinical Laboratory Fee Schedule 2026
- 03cms.govhttps://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits
Mira Scribe
Mira Scribe records the fever history, the suspected source, and the antibiotic timing as the provider discusses them, so the culture order lines up with a documented infection concern.
See how Mira captures CPT 87040 documentation