CPT code 87255: HSV isolation, culture with identification2026 Medicare lab fee · Clinical Laboratory Fee Schedule
Herpes simplex virus isolation with non-immunologic identification is reported when a laboratory cultures a specimen to recover and identify HSV.
Medicare pays $33.86 for 87255 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
$33.86
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 87255 covers
Code 87255 is used when a laboratory recovers HSV from a submitted specimen and identifies the isolate through a non-immunologic method, rather than relying only on visible cytopathic changes. This culture-based approach is used in evaluating suspected HSV infection; material from an active lesion is a common culture specimen. Clinical laboratories perform the service for patients seen in office-based or hospital settings.
Report 87255 for HSV isolation and identification when that is the method performed; it is distinct from HSV antigen detection by immunofluorescence. Medicare pays 87255 only through the CLFS. The 2026 national amount is $33.86, unchanged from 2020 through 2026. The same national amount applies across localities, with no geographic or office/facility adjustment.
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 87255
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 87255. 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 87255 with status X (excluded by statute), so the test itself is paid only from the CLFS.
87255 on the lab fee schedule since 2020
87255 · CLFS 2026 Q4 (current)
$33.86
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.
87255 compared with similar tests
- 87273HSV-2 antigenImmunofluorescence method$11.98
- Choose 87273 for HSV-2 antigen detection by immunofluorescence. Choose 87255 when the laboratory isolates HSV and identifies it using a non-immunologic method.
- 87274HSV-1 antigenImmunofluorescent detection$11.98
- Choose 87274 for HSV-1 antigen detection by immunofluorescence. Code 87255 describes HSV isolation and non-immunologic identification.
- 87252Virus cultureTissue culture method$26.07
- Code 87252 describes virus inoculation in tissue culture; 87255 is for HSV isolation and identification using a non-immunologic method.
87255 billing questions
When should I choose 87255 instead of an HSV antigen test?
Use 87255 when the laboratory performs HSV isolation and non-immunologic identification. HSV antigen detection by immunofluorescence is reported with the code matching the HSV type tested.
How does 87255 differ from 87252?
Code 87255 describes HSV isolation and identification using a non-immunologic method. Code 87252 describes virus inoculation in tissue culture.
What specimen is typically submitted for HSV isolation?
Material from an active lesion is commonly submitted for culture. The test seeks to recover virus from the specimen.
How does Medicare pay for 87255?
Medicare pays 87255 through the CLFS only. The national amount applies across localities without an office or 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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