CPT code 0402U: STI multiplex, four pathogen targets2026 Medicare lab fee · Clinical Laboratory Fee Schedule
A multiplex amplified-probe assay detects four sexually transmitted infection pathogens in specified genital or urine specimens and reports each target separately.
Medicare pays $142.63 for 0402U 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
$142.63
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2024
- 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 0402U covers
This proprietary laboratory analysis uses a multiplex amplified-probe method to test for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium. The assay detects these organisms in vaginal, endocervical, or male urine specimens. Each of the four targets receives its own detected/not-detected result, so the report identifies which organisms were found rather than giving one combined STI result. Clinicians may order the test when evaluating suspected sexually transmitted infection; laboratories perform and report the molecular test in clinical laboratory settings.
Report 0402U once for the multiplex assay; do not count its four organism-level results as four units. Medicare pays 0402U under the CLFS at one national amount, with the same amount across localities and no office/facility payment difference. The 2026 national CLFS amount is $142.63, unchanged from 2024 and 2025.
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 0402U
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 0402U. 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.
Not on the physician fee schedule
The physician fee schedule doesn’t list 0402U: Medicare pays the test only from the CLFS.
0402U on the lab fee schedule since 2023
0402U · CLFS 2026 Q4 (current)
$142.63
Unchanged since Jan 1, 2024
Every change on file
- Jan 1, 2024 · CLFS 2024 Q1MAC-priced → $142.63
13 quarterly CLFS releases on file, first CLFS 2023 Q4. A code missing from a quarter wasn’t on that release.
0402U compared with similar tests
- 87491Chlamydia testAmplified nucleic acid detection$35.09
- Use 87491 for a Chlamydia trachomatis amplified-probe test. Use 0402U when the laboratory performs the described multiplex assay covering four STI organisms.
- 87591Gonorrhea testAmplified DNA probe$35.09
- Use 87591 for a Neisseria gonorrhoeae amplified-probe test. It does not represent the four-organism multiplex service described by 0402U.
- 87661Trichomonas testAmplified nucleic acid$35.09
- Use 87661 for a Trichomonas vaginalis nucleic-acid test. Choose 0402U when the laboratory performs the four-target multiplex assay instead.
- 87563M. genitalium testAmplified nucleic acid probe$35.09
- Use 87563 for an individual Mycoplasma genitalium nucleic-acid test. 0402U represents the multiplex assay that also tests three other STI organisms.
0402U billing questions
Which organisms does 0402U test for?
It tests for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium. The laboratory reports a detected or not-detected result for each organism.
Which specimens are specified for this test?
The specified specimens are vaginal, endocervical, and male urine. The test uses a multiplex amplified-probe method.
Should the four organism results be billed as four units?
No. Report 0402U once for the multiplex assay, not as a separate unit for each pathogen result.
How is 0402U paid by Medicare?
Medicare pays it through the CLFS at one national amount across localities, with no office or facility payment difference.
How does 0402U differ from an individual organism test?
0402U describes one multiplex assay covering four pathogens. Codes such as 87491 or 87591 describe testing for an individual organism rather than this four-target assay.
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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