CPT code 84703: Pregnancy test, qualitative hCG2026 Medicare lab fee · Clinical Laboratory Fee Schedule
A qualitative hCG assay detects chorionic gonadotropin to support pregnancy assessment when a result indicating presence or absence is needed.
Medicare pays $7.52 for 84703 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
$7.52
In effect since Jan 1, 2026. The same amount in every state, payment locality and setting.
- Geographic adjustment
- None
- Office vs facility
- Same
- Since 2020
- Unchanged
- QW · CLIA-waived test
- $7.52
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 84703 covers
This assay checks for the presence of human chorionic gonadotropin (hCG), a reproductive hormone, without measuring its concentration. It is used in pregnancy assessment, including when a clinician needs a qualitative result rather than a numerical hCG level. Clinical laboratories and office-based testing sites may perform the assay; waived testing is available at sites with a CLIA certificate of waiver when the test is performed under the applicable waived conditions.
Report 84703 for a qualitative hCG assay, rather than a quantitative hCG measurement. When the waived version is performed at a site holding a CLIA certificate of waiver, report modifier QW. Medicare pays the test only through the CLFS. The 2026 national CLFS amount is $7.52, unchanged from 2020 through 2026; the same amount applies across localities, with no geographic or office-versus-facility adjustment. There is no separate physician-fee-schedule payment for this test.
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 84703
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 84703. 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.
Excluded from the physician fee schedule
The physician fee schedule lists 84703 with status X (excluded by statute), so the test itself is paid only from the CLFS.
CLIA-waived version (QW)
CMS also lists 84703 with modifier QW, the version labs holding a CLIA certificate of waiver bill. It pays $7.52.
84703 on the lab fee schedule since 2020
84703 · CLFS 2026 Q4 (current)
$7.52
Unchanged since Jan 1, 2020
27 quarterly CLFS releases on file, first CLFS 2020 Q1. A code missing from a quarter wasn’t on that release.
84703 compared with similar tests
- 84702hCG testQuantitative level$15.05
- 84703 reports a qualitative hCG result; 84702 reports a quantitative measurement of hCG.
- 81025Urine pregnancy testVisual color method$8.61
- 81025 is specifically for a urine pregnancy test. Choose 84703 for a qualitative hCG assay that is not being reported as that specific urine test.
- 84704Free beta hCGFree beta chain$15.29
- 84704 measures free beta hCG. Code 84703 is for qualitative hCG detection, not a free-beta-chain assay.
84703 billing questions
When should 84703 be reported instead of 84702?
Report 84703 when the assay provides a qualitative result indicating whether hCG is detected. Use 84702 when the test measures the amount of hCG.
How does 84703 differ from 81025?
Code 81025 identifies a urine pregnancy test. Code 84703 identifies a qualitative hCG assay and is not limited by its code description to that urine-test method.
When is modifier QW appropriate?
Use QW when the CLIA-waived version is performed at a site holding a CLIA certificate of waiver and the test is performed under waived conditions.
How does Medicare pay for 84703?
Medicare pays 84703 through the CLFS at one national amount per code, regardless of locality or office versus facility setting.
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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