CPT code 87205: Gram stain, primary-source smear2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Reports interpretation of a primary-source smear stained with Gram or Giemsa to assess bacteria, fungi, or cell types in a specimen.
Medicare pays $4.27 for 87205 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 87205 covers
A laboratory applies a Gram or Giemsa stain to a smear from a primary source and interprets the preparation. The examination is used to assess bacteria, fungi, or cell types in the specimen. Code selection follows the stain and examination performed: 87205 identifies the Gram- or Giemsa-stained smear, distinct from fluorescent or acid staining, other special or complex stains, and wet-mount examination. This code describes smear examination, not the separate laboratory work of culturing a specimen or examining tissue for fungi.
Medicare pays 87205 through the CLFS, with one national amount across states and localities and no office or facility difference. The 2026 national amount is $4.27, unchanged since 2020. The service is excluded from the physician fee schedule and paid only through the CLFS.
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 87205
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 87205. 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 87205 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87205 on the lab fee schedule since 2020
87205 · 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.
87205 compared with similar tests
- 87206Microbial smearFluorescent or acid-fast$5.39
- Choose 87205 for a Gram- or Giemsa-stained smear; 87206 identifies a smear using fluorescent or acid staining.
- 87207Special stainInclusion bodies or parasites$5.99
- Code 87205 is for a Gram- or Giemsa-stained smear; 87207 identifies a special-stain smear service.
- 87209Parasite stainComplex special stain$17.98
- Code 87205 identifies Gram or Giemsa staining; 87209 identifies a complex-stain smear service.
- 87210Wet mountSaline, India ink, or KOH$5.82
- Use 87205 for the Gram- or Giemsa-stained smear service. Code 87210 describes a wet-mount examination.
87205 billing questions
When should 87205 be chosen over a wet mount?
Use 87205 for a primary-source smear stained with Gram or Giemsa. Code 87210 describes a wet-mount examination.
How does 87205 differ from 87206?
Code 87205 identifies a Gram- or Giemsa-stained smear. Code 87206 is for a smear using fluorescent or acid staining.
Does 87205 include a culture?
No. It identifies the stained smear and its interpretation, not culture.
Is 87205 paid under the physician fee schedule?
No. Medicare pays 87205 through the CLFS; the service is excluded from the physician fee schedule.
How does Medicare pay 87205 across locations?
The CLFS amount is national and applies across localities, with no office or facility difference.
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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