CPT code 0484U: M. genitalium resistance, macrolide resistance probability2026 Medicare lab fee · Clinical Laboratory Fee Schedule
This assay estimates the probability of macrolide resistance in Mycoplasma genitalium from oral, rectal, or vaginal swab specimens.
Medicare pays $35.09 for 0484U 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
$35.09
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2026
- 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 0484U covers
This proprietary laboratory analysis evaluates 23S rRNA point mutations in Mycoplasma genitalium and uses an algorithm to estimate the probability of macrolide resistance. The test is performed on an oral, rectal, or vaginal swab. It addresses resistance probability rather than establishing whether M. genitalium is present, so it answers a different question from an organism-detection assay. Clinicians may consider it when resistance information is relevant to evaluating M. genitalium infection.
Report 0484U for the described resistance analysis. Medicare pays the code only through the CLFS, at one nationally set amount that is the same across localities and has no office-versus-facility adjustment; the 2026 national amount is $35.09. The code has no physician fee schedule payment.
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 0484U
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 0484U. 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 0484U: Medicare pays the test only from the CLFS.
0484U on the lab fee schedule since 2024
0484U · CLFS 2026 Q4 (current)
$35.09
Unchanged since Jan 1, 2026
Every change on file
- Jan 1, 2026 · CLFS 2026 Q1MAC-priced → $35.09
9 quarterly CLFS releases on file, first CLFS 2024 Q4. A code missing from a quarter wasn’t on that release.
0484U compared with similar tests
- 87563M. genitalium testAmplified nucleic acid probe$35.09
- 87563 tests for M. genitalium itself. Code 0484U estimates the probability of macrolide resistance rather than detecting the organism.
- 0483UGonorrhea resistancegyrA S91F mutation$35.09
- 0483U evaluates a gyrA point mutation associated with Neisseria gonorrhoeae resistance. Code 0484U evaluates macrolide resistance in M. genitalium.
0484U billing questions
Does 0484U detect M. genitalium?
No. It estimates the probability of macrolide resistance from 23S rRNA point mutations; it does not establish whether the organism is present.
How is 0484U different from 87563?
CPT 87563 detects M. genitalium by nucleic acid testing. Code 0484U estimates the probability of macrolide resistance.
Which specimens are used for this assay?
The assay is performed on an oral, rectal, or vaginal swab.
How does Medicare pay 0484U?
Medicare pays it through the CLFS at one national amount, without geographic or office-versus-facility adjustment.
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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