CPT code 87220: KOH examination, skin, hair, or nail specimens2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Direct KOH microscopy of skin, hair, or nail material evaluates suspected fungal infection or ectoparasites such as scabies mites and ova.
Medicare pays $4.27 for 87220 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 87220 covers
This service examines skin scrapings or scales, hair, or nail material prepared with potassium hydroxide (KOH). The preparation clears keratin so fungal elements or ectoparasite ova and mites, including those associated with scabies, can be seen microscopically. Dermatologists and other clinicians commonly order it for suspected superficial fungal infection or scabies; testing may be performed in an office laboratory or a clinical microbiology laboratory.
Report the direct microscopic examination when it is performed, separately from a fungal culture when both services are done. Medicare pays this test only through the CLFS. The 2026 national CLFS amount is $4.27, unchanged from 2020 through 2026; the same amount applies across localities and settings, without geographic or office-versus-facility adjustment. The physician fee schedule excludes this test 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 87220
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 87220. 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 87220 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87220 on the lab fee schedule since 2020
87220 · 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.
87220 compared with similar tests
- 87101Fungal cultureSkin, hair, or nail$7.71
- 87220 is direct KOH microscopy of skin, hair, or nail material; 87101 reports fungal culture. Both may be reported when both examinations are performed.
- 87210Wet mountSaline, India ink, or KOH$5.82
- 87220 is the KOH examination for skin, hair, or nail material. 87210 is used for a wet-mount examination, such as a saline or ink preparation.
- 87205Gram stainPrimary-source smear$4.27
- 87220 evaluates skin, hair, or nail material by KOH microscopy for fungi or ectoparasites. 87205 is for a Gram-stained smear when that examination is performed.
- 87206Microbial smearFluorescent or acid-fast$5.39
- Choose 87220 for the KOH preparation of skin, hair, or nail material. Choose 87206 when the direct smear is examined using a fluorescent or acid stain.
87220 billing questions
When should 87220 be used instead of a fungal culture?
Use 87220 for the direct KOH microscopic examination of skin, hair, or nail material. A fungal culture is a separate test when culture is performed.
Can 87220 and a fungal culture be reported for the same specimen?
Yes, when both the direct KOH examination and culture are performed. Report the culture separately rather than treating it as part of the microscopic examination.
Which specimens fit this code?
The examination is for material from skin, hair, or nails. It evaluates fungal elements or ectoparasite ova and mites.
Does Medicare pay 87220 under the physician fee schedule?
No. Medicare pays the test through the CLFS; the physician fee schedule lists it as excluded by statute.
Does the CLFS amount vary by location or setting?
No. The national amount applies across states and localities, with no 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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