CPT code 87168: Arthropod exam, visual inspection2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Code 87168 reports a laboratory’s macroscopic visual examination of an insect or other arthropod specimen.
Medicare pays $4.27 for 87168 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
$4.27
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
- 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 87168 covers
The service is a macroscopic visual examination of an insect or other arthropod. The laboratory examines the arthropod by sight, and 87168 identifies this specimen and examination type. This is distinct from a macroscopic parasite examination reported with 87169 and from ova-and-parasite smear testing described by 87177. Report 87168 when the service performed is the visual examination of an arthropod.
Medicare pays 87168 through the CLFS only, using one national amount per code across states and localities, without geographic adjustment or an office/facility difference. The 2026 national amount is $4.27, unchanged from 2020 through 2026. The physician fee schedule excludes the code by statute.
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 87168
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 87168. 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 87168 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87168 on the lab fee schedule since 2020
87168 · CLFS 2026 Q4 (current)
$4.27
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.
87168 compared with similar tests
- 87169Parasite examVisual inspection$4.31
- Choose 87168 for an insect or other arthropod examined visually; choose 87169 for macroscopic examination of a parasite.
- 87177Ova and parasitesSmear and concentration$8.90
- 87168 describes macroscopic visual examination of an arthropod. Code 87177 describes ova-and-parasite smears.
- 87172Pinworm examPerianal tape preparation$4.27
- 87172 is the pinworm examination code. Code 87168 describes macroscopic visual examination of an insect or other arthropod.
87168 billing questions
When should I report 87168 rather than 87169?
Report 87168 for macroscopic visual examination of an arthropod. Code 87169 describes macroscopic examination of a parasite.
Is 87168 the code for an ova-and-parasite smear examination?
No. Code 87168 describes visual examination of an arthropod; 87177 describes ova-and-parasite smears.
Does 87168 describe a visual or microscopic examination?
It describes macroscopic visual examination of an insect or other arthropod.
How does Medicare pay 87168?
Medicare pays it through the CLFS only, at one national amount that applies across localities and office and facility settings.
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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